{"hospital_name":"AdventHealth Deland","last_updated_on":"2026-04-01","version":"3.0.0","location_name":["AdventHealth Deland"],"hospital_address":["701 W Plymouth Ave, Deland, FL 32720"],"license_information":{"license_number":"4436","state":"FL"},"type_2_npi":["1649367269","1265529887"],"attestation":{"attestation":"To the best of its knowledge and belief, this hospital has included all applicable standard charge information in accordance with the requirements of 45 CFR 180.50, and the information encoded is true, accurate, and complete as of the date in the file. This hospital has included all payer-specific negotiated charges in dollars that can be expressed as a dollar amount. For payer-specific negotiated charges that cannot be expressed as a dollar amount in the machine-readable file or not knowable in advance, the hospital attests that the payer-specific negotiated charge is based on a contractual algorithm, percentage or formula that precludes the provision of a dollar amount and has provided all necessary information available to the hospital for the public to be able to derive the dollar amount, including, but not limited to, the specific fee schedule or components referenced in such percentage, algorithm or formula.","confirm_attestation":true,"attester_name":"Tim Reiner "},"modifier_information":[{"description":"Technical Component; represents the costs of equipment, supplies, and technician personnel for a procedure, excluding the physician's interpretation. It is used when only the technical portion of a test is billed, typically by hospitals, imaging centers, or independent diagnostic testing facilities","code":"TC","modifier_payer_information":[{"payer_name":"Aetna","plan_name":"AdventHealth Corporate Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"ASA PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Healthy Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Aetna","plan_name":"QHP Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"Allegiance/Health First","plan_name":"Employee HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"AvMed","plan_name":"HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueOptions Network Blue PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"BlueSelect PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"HealthOptions HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"MyBlue HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"PPC PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"BCBS","plan_name":"Traditional","description":"The modified price is presented in the standard charge value."},{"payer_name":"Carelon","plan_name":"Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"CastCare Disney HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"County of Volusia HMO Employee","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Evernorth Medicare Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Cigna","plan_name":"Surefit EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"First Health/Coventry","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Florida Community Care","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Florida Health Care Plan","plan_name":"Self Funded HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option HMO/POS/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health First Health Plans","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"CarePlus Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucet Health","plan_name":"HMO Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Lucet Health","plan_name":"MyBlue Behavioral Health Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Magellan Health","plan_name":"Medicare Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Multiplan","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Oscar","plan_name":"Individual EPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Plotkin Health","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Simply Healthcare","plan_name":"Clear Health Alliance Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Simply Healthcare","plan_name":"Healthy Kids Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Compass Exchange","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"International HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicaid Managed Care Plan","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - Behavioral Health","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"Neighborhood Health Partnership (NHP) HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UnitedHealthCare","plan_name":"NEXUS HMO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UPMC Health Plan","plan_name":"HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"UPMC Health Plan","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - HMO/PPO","description":"The modified price is presented in the standard charge value."}]}],"standard_charge_information":[{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150012030","type":"NDC"}],"standard_charges":[{"gross_charge":55.35,"discounted_cash":55.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"DIPHENHYDRAMINE-ZINC ACETATE 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802035803","type":"NDC"}],"standard_charges":[{"gross_charge":20.89,"discounted_cash":20.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536131628","type":"NDC"}],"standard_charges":[{"gross_charge":29.88,"discounted_cash":29.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006435","type":"NDC"}],"standard_charges":[{"gross_charge":20.91,"discounted_cash":20.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"58602060407","type":"NDC"}],"standard_charges":[{"gross_charge":105.68,"discounted_cash":105.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"AQUAPHOR ADVANCED THERAPY EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72140063377","type":"NDC"}],"standard_charges":[{"gross_charge":103.36,"discounted_cash":103.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"53329008701","type":"NDC"}],"standard_charges":[{"gross_charge":30.37,"discounted_cash":30.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201302","type":"NDC"}],"standard_charges":[{"gross_charge":41.46,"discounted_cash":41.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014301","type":"NDC"}],"standard_charges":[{"gross_charge":27.35,"discounted_cash":27.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 GR"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168002031","type":"NDC"}],"standard_charges":[{"gross_charge":62.56,"discounted_cash":62.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.35 GR"}]},{"description":"POLYETHYLENE GLYCOL 3350 17 GM/SCOOP PO POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802086801","type":"NDC"}],"standard_charges":[{"gross_charge":37.68,"discounted_cash":37.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 119 GR"}]},{"description":"AMMONIUM LACTATE 12 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904598426","type":"NDC"}],"standard_charges":[{"gross_charge":49.26,"discounted_cash":49.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 226 GR"}]},{"description":"MENTHOL-ZINC OXIDE 0.44-20.625 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10135070104","type":"NDC"}],"standard_charges":[{"gross_charge":43.65,"discounted_cash":43.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 GR"}]},{"description":"RECTASMOOTHE 5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030130","type":"NDC"}],"standard_charges":[{"gross_charge":92.23,"discounted_cash":92.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672131200","type":"NDC"}],"standard_charges":[{"gross_charge":33.87,"discounted_cash":33.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"ANECREAM 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24357070106","type":"NDC"}],"standard_charges":[{"gross_charge":39.98,"discounted_cash":39.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"TRIPLE ANTIBIOTIC 5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68001048346","type":"NDC"}],"standard_charges":[{"gross_charge":29.64,"discounted_cash":29.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"GNP TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122041403","type":"NDC"}],"standard_charges":[{"gross_charge":25.52,"discounted_cash":25.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"AMERICAINE 20 % EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63736037882","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574402450","type":"NDC"}],"standard_charges":[{"gross_charge":87.29,"discounted_cash":87.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574402439","type":"NDC"}],"standard_charges":[{"gross_charge":84.51,"discounted_cash":84.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"BUDESONIDE-FORMOTEROL FUMARATE 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00310737020","type":"NDC"}],"standard_charges":[{"gross_charge":644.32,"discounted_cash":644.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.2 GR"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802021001","type":"NDC"}],"standard_charges":[{"gross_charge":1056.15,"discounted_cash":1056.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714098701","type":"NDC"}],"standard_charges":[{"gross_charge":93.65,"discounted_cash":93.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168009915","type":"NDC"}],"standard_charges":[{"gross_charge":85.92,"discounted_cash":85.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"BETAMETHASONE DIPROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168005546","type":"NDC"}],"standard_charges":[{"gross_charge":295.88,"discounted_cash":295.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180096301","type":"NDC"}],"standard_charges":[{"gross_charge":109.47,"discounted_cash":109.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.5 GR"}]},{"description":"BACITRACIN-POLYMYXIN B 500-10000 UNIT/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208055555","type":"NDC"}],"standard_charges":[{"gross_charge":79.7,"discounted_cash":79.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063136","type":"NDC"}],"standard_charges":[{"gross_charge":127.81,"discounted_cash":127.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"GNP TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122041405","type":"NDC"}],"standard_charges":[{"gross_charge":23.82,"discounted_cash":23.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672128202","type":"NDC"}],"standard_charges":[{"gross_charge":39.79,"discounted_cash":39.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672200201","type":"NDC"}],"standard_charges":[{"gross_charge":32.18,"discounted_cash":32.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168025815","type":"NDC"}],"standard_charges":[{"gross_charge":111.02,"discounted_cash":111.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"ESTRADIOL 0.1 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093354143","type":"NDC"}],"standard_charges":[{"gross_charge":98.19,"discounted_cash":98.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082901","type":"NDC"}],"standard_charges":[{"gross_charge":82.62,"discounted_cash":82.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054327099","type":"NDC"}],"standard_charges":[{"gross_charge":111.45,"discounted_cash":111.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 GR"}]},{"description":"LIDOCAINE 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328002455","type":"NDC"}],"standard_charges":[{"gross_charge":35.86,"discounted_cash":35.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68462018117","type":"NDC"}],"standard_charges":[{"gross_charge":124.92,"discounted_cash":124.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536118365","type":"NDC"}],"standard_charges":[{"gross_charge":84.13,"discounted_cash":84.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15.8 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030660","type":"NDC"}],"standard_charges":[{"gross_charge":308.17,"discounted_cash":308.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268056815","type":"NDC"}],"standard_charges":[{"gross_charge":37.07,"discounted_cash":37.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574402435","type":"NDC"}],"standard_charges":[{"gross_charge":97.31,"discounted_cash":97.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00781729685","type":"NDC"}],"standard_charges":[{"gross_charge":100.17,"discounted_cash":100.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.7 GR"}]},{"description":"GENTAMICIN SULFATE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713068215","type":"NDC"}],"standard_charges":[{"gross_charge":85.28,"discounted_cash":85.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014303","type":"NDC"}],"standard_charges":[{"gross_charge":34.28,"discounted_cash":34.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68462018022","type":"NDC"}],"standard_charges":[{"gross_charge":39.53,"discounted_cash":39.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043803","type":"NDC"}],"standard_charges":[{"gross_charge":24.24,"discounted_cash":24.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"HYDROCORTISONE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802027603","type":"NDC"}],"standard_charges":[{"gross_charge":28.07,"discounted_cash":28.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536129497","type":"NDC"}],"standard_charges":[{"gross_charge":104.39,"discounted_cash":104.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802095301","type":"NDC"}],"standard_charges":[{"gross_charge":87.66,"discounted_cash":87.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"DIBUCAINE 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536121195","type":"NDC"}],"standard_charges":[{"gross_charge":44.52,"discounted_cash":44.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802011222","type":"NDC"}],"standard_charges":[{"gross_charge":69.54,"discounted_cash":69.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012425","type":"NDC"}],"standard_charges":[{"gross_charge":90.24,"discounted_cash":90.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59762013102","type":"NDC"}],"standard_charges":[{"gross_charge":90.24,"discounted_cash":90.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877047379","type":"NDC"}],"standard_charges":[{"gross_charge":95.27,"discounted_cash":95.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672302009","type":"NDC"}],"standard_charges":[{"gross_charge":65.66,"discounted_cash":65.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714087801","type":"NDC"}],"standard_charges":[{"gross_charge":128.86,"discounted_cash":128.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"CLINDAMYCIN PHOS (TWICE-DAILY) 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"21922002705","type":"NDC"}],"standard_charges":[{"gross_charge":84.96,"discounted_cash":84.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005935","type":"NDC"}],"standard_charges":[{"gross_charge":51.37,"discounted_cash":51.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"HYDROCORTISONE (PERIANAL) 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62559043130","type":"NDC"}],"standard_charges":[{"gross_charge":93.84,"discounted_cash":93.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802024414","type":"NDC"}],"standard_charges":[{"gross_charge":46.35,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012450","type":"NDC"}],"standard_charges":[{"gross_charge":81.34,"discounted_cash":81.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208079535","type":"NDC"}],"standard_charges":[{"gross_charge":124.34,"discounted_cash":124.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030630","type":"NDC"}],"standard_charges":[{"gross_charge":251.44,"discounted_cash":251.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"METRONIDAZOLE 0.75 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168032346","type":"NDC"}],"standard_charges":[{"gross_charge":295.49,"discounted_cash":295.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208091055","type":"NDC"}],"standard_charges":[{"gross_charge":117.63,"discounted_cash":117.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"PRIVIGEN 10 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043710","type":"NDC"}],"standard_charges":[{"gross_charge":2953.53,"discounted_cash":2953.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PRIVIGEN 40 GM/400ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043940","type":"NDC"}],"standard_charges":[{"gross_charge":10980.46,"discounted_cash":10980.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"ELUCIREM 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"67684423202","type":"NDC"}],"standard_charges":[{"gross_charge":113.82,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.7 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270702038","type":"NDC"}],"standard_charges":[{"gross_charge":1.49,"discounted_cash":1.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270702540","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270703042","type":"NDC"}],"standard_charges":[{"gross_charge":67.49,"discounted_cash":67.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131535","type":"NDC"}],"standard_charges":[{"gross_charge":1.54,"discounted_cash":1.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131530","type":"NDC"}],"standard_charges":[{"gross_charge":1.45,"discounted_cash":1.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131550","type":"NDC"}],"standard_charges":[{"gross_charge":22.38,"discounted_cash":22.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 65 ML"}]},{"description":"OPTISON IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9956","type":"HCPCS"},{"code":"00407270703","type":"NDC"}],"standard_charges":[{"gross_charge":59.53,"discounted_cash":59.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032513","type":"NDC"}],"standard_charges":[{"gross_charge":87.55,"discounted_cash":87.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032512","type":"NDC"}],"standard_charges":[{"gross_charge":62.73,"discounted_cash":62.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.4 ML"}]},{"description":"GADAVIST 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"50419032511","type":"NDC"}],"standard_charges":[{"gross_charge":1.43,"discounted_cash":1.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DOTAREM 7.5 MMOL/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200102","type":"NDC"}],"standard_charges":[{"gross_charge":0.72,"discounted_cash":0.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DOTAREM 7.5 MMOL/15ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684300102","type":"NDC"}],"standard_charges":[{"gross_charge":60.7,"discounted_cash":60.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"DOTAREM 10 MMOL/20ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684300103","type":"NDC"}],"standard_charges":[{"gross_charge":96.44,"discounted_cash":96.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEFINITY 6.52 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9957","type":"HCPCS"},{"code":"11994001104","type":"NDC"}],"standard_charges":[{"gross_charge":194.22,"discounted_cash":194.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516413","type":"NDC"}],"standard_charges":[{"gross_charge":0.66,"discounted_cash":0.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516414","type":"NDC"}],"standard_charges":[{"gross_charge":56.68,"discounted_cash":56.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.6 ML"}]},{"description":"L.E.T. 4-0.05-0.5 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70092161243","type":"NDC"}],"standard_charges":[{"gross_charge":180.61,"discounted_cash":180.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LACTULOSE 20 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00116400541","type":"NDC"}],"standard_charges":[{"gross_charge":13.21,"discounted_cash":13.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GADOTERATE MEGLUMINE 7.5 MMOL/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"65219008415","type":"NDC"}],"standard_charges":[{"gross_charge":113.82,"discounted_cash":113.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GADOBUTROL 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"65219028110","type":"NDC"}],"standard_charges":[{"gross_charge":38.86,"discounted_cash":38.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.7 ML"}]},{"description":"GADOBUTROL 1 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9585","type":"HCPCS"},{"code":"65219028107","type":"NDC"}],"standard_charges":[{"gross_charge":35.57,"discounted_cash":35.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.3 ML"}]},{"description":"CLARISCAN 10 MMOL/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"00407294305","type":"NDC"}],"standard_charges":[{"gross_charge":206.75,"discounted_cash":206.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DOTAREM 10 MMOL/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200103","type":"NDC"}],"standard_charges":[{"gross_charge":8.19,"discounted_cash":8.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.1 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219038310","type":"NDC"}],"standard_charges":[{"gross_charge":86.89,"discounted_cash":86.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 ML"}]},{"description":"IODIXANOL 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"65219038305","type":"NDC"}],"standard_charges":[{"gross_charge":12.41,"discounted_cash":12.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131652","type":"NDC"}],"standard_charges":[{"gross_charge":0.79,"discounted_cash":0.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OCTAGAM 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982084003","type":"NDC"}],"standard_charges":[{"gross_charge":454.03,"discounted_cash":454.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"NYSTATIN-TRIAMCINOLONE 100000-0.1 UNIT/GM-% EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672126302","type":"NDC"}],"standard_charges":[{"gross_charge":68.74,"discounted_cash":68.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"PRIVIGEN 20 GM/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043820","type":"NDC"}],"standard_charges":[{"gross_charge":6230.26,"discounted_cash":6230.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"DOTAREM 5 MMOL/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200101","type":"NDC"}],"standard_charges":[{"gross_charge":35.97,"discounted_cash":35.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"REFRESH LACRI-LUBE OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00023031204","type":"NDC"}],"standard_charges":[{"gross_charge":117.63,"discounted_cash":117.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672404801","type":"NDC"}],"standard_charges":[{"gross_charge":110.97,"discounted_cash":110.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"STYE 31.9-57.7 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63736014308","type":"NDC"}],"standard_charges":[{"gross_charge":65.29,"discounted_cash":65.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"SORE THROAT 15-3.6 MG MT LOZG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904625549","type":"NDC"}],"standard_charges":[{"gross_charge":6.66,"discounted_cash":6.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"TRIPLE ANTIBIOTIC 3.5-400-5000 EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802014370","type":"NDC"}],"standard_charges":[{"gross_charge":5.0,"discounted_cash":5.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"TRIPLE ANTIBIOTIC EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904880567","type":"NDC"}],"standard_charges":[{"gross_charge":4.54,"discounted_cash":4.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"HURRICAINE ONE 20 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00283061026","type":"NDC"}],"standard_charges":[{"gross_charge":122.82,"discounted_cash":122.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ANORO ELLIPTA 62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173086910","type":"NDC"}],"standard_charges":[{"gross_charge":994.66,"discounted_cash":994.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 UN"}]},{"description":"ANORO ELLIPTA 62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173086906","type":"NDC"}],"standard_charges":[{"gross_charge":297.95,"discounted_cash":297.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 UN"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68001047748","type":"NDC"}],"standard_charges":[{"gross_charge":5.41,"discounted_cash":5.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896014514","type":"NDC"}],"standard_charges":[{"gross_charge":3.55,"discounted_cash":3.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904702367","type":"NDC"}],"standard_charges":[{"gross_charge":4.17,"discounted_cash":4.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904740267","type":"NDC"}],"standard_charges":[{"gross_charge":4.25,"discounted_cash":4.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006070","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"TRELEGY ELLIPTA 200-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173089314","type":"NDC"}],"standard_charges":[{"gross_charge":727.61,"discounted_cash":727.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 UN"}]},{"description":"TRELEGY ELLIPTA 100-62.5-25 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173088714","type":"NDC"}],"standard_charges":[{"gross_charge":739.51,"discounted_cash":739.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 UN"}]},{"description":"INCRUSE ELLIPTA 62.5 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173087306","type":"NDC"}],"standard_charges":[{"gross_charge":66.21,"discounted_cash":66.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ARNUITY ELLIPTA 100 MCG/ACT IN AEPB","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173087414","type":"NDC"}],"standard_charges":[{"gross_charge":309.44,"discounted_cash":309.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 UN"}]},{"description":"CEPACOL EXTRA STRENGTH 15-2.6 MG MT LOZG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63824073216","type":"NDC"}],"standard_charges":[{"gross_charge":5.49,"discounted_cash":5.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CHLORASEPTIC SORE THROAT 6-10 MG MT LOZG","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"78112001106","type":"NDC"}],"standard_charges":[{"gross_charge":5.29,"discounted_cash":5.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LUBRIFRESH P.M. OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904648838","type":"NDC"}],"standard_charges":[{"gross_charge":60.24,"discounted_cash":60.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"SOOTHE NIGHTTIME OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10119002239","type":"NDC"}],"standard_charges":[{"gross_charge":89.07,"discounted_cash":89.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011720","type":"NDC"}],"standard_charges":[{"gross_charge":64.59,"discounted_cash":64.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ADRENALIN-NACL 4-0.9 MG/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"42023031510","type":"NDC"}],"standard_charges":[{"gross_charge":225.83,"discounted_cash":225.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"HYDROMORPHONE 1 MG/ML (50 ML) IN NACL PCA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"258","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092129474","type":"NDC"}],"standard_charges":[{"gross_charge":242.25,"discounted_cash":242.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046437","type":"NDC"}],"standard_charges":[{"gross_charge":15.42,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MULTIHANCE 529 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9577","type":"HCPCS"},{"code":"00270516415","type":"NDC"}],"standard_charges":[{"gross_charge":154.11,"discounted_cash":154.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"RECOMBIVAX HB 10 MCG/ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"90746","type":"HCPCS"},{"code":"00006409402","type":"NDC"}],"standard_charges":[{"gross_charge":140.27,"discounted_cash":140.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"EOVIST 0.25 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9581","type":"HCPCS"},{"code":"50419032005","type":"NDC"}],"standard_charges":[{"gross_charge":264.52,"discounted_cash":264.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 ML"}]},{"description":"PRIVIGEN 5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1459","type":"HCPCS"},{"code":"44206043605","type":"NDC"}],"standard_charges":[{"gross_charge":1878.09,"discounted_cash":1878.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131604","type":"NDC"}],"standard_charges":[{"gross_charge":39.48,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 105 ML"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043401","type":"NDC"}],"standard_charges":[{"gross_charge":39.79,"discounted_cash":39.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005911","type":"NDC"}],"standard_charges":[{"gross_charge":80.71,"discounted_cash":80.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"SANTYL 250 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50484001030","type":"NDC"}],"standard_charges":[{"gross_charge":884.36,"discounted_cash":884.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"ARTHRITIS PAIN RELIEVING 0.075 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536111825","type":"NDC"}],"standard_charges":[{"gross_charge":48.2,"discounted_cash":48.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"ESTRACE 0.1 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00430375414","type":"NDC"}],"standard_charges":[{"gross_charge":997.83,"discounted_cash":997.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"PREMARIN 0.625 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00046087221","type":"NDC"}],"standard_charges":[{"gross_charge":1308.63,"discounted_cash":1308.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013140","type":"NDC"}],"standard_charges":[{"gross_charge":210.51,"discounted_cash":210.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 GR"}]},{"description":"SSD 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43598021055","type":"NDC"}],"standard_charges":[{"gross_charge":96.03,"discounted_cash":96.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013125","type":"NDC"}],"standard_charges":[{"gross_charge":66.43,"discounted_cash":66.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013150","type":"NDC"}],"standard_charges":[{"gross_charge":123.7,"discounted_cash":123.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"SSD 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43598021025","type":"NDC"}],"standard_charges":[{"gross_charge":69.97,"discounted_cash":69.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013120","type":"NDC"}],"standard_charges":[{"gross_charge":104.65,"discounted_cash":104.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 GR"}]},{"description":"SILVADENE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61570013155","type":"NDC"}],"standard_charges":[{"gross_charge":97.31,"discounted_cash":97.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 GR"}]},{"description":"FIRST AID ANTISEPTIC 10 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536127180","type":"NDC"}],"standard_charges":[{"gross_charge":22.61,"discounted_cash":22.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"GENTEAL TEARS NIGHT-TIME OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065051801","type":"NDC"}],"standard_charges":[{"gross_charge":86.91,"discounted_cash":86.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"CETACAINE 2-2-14 % EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10223020103","type":"NDC"}],"standard_charges":[{"gross_charge":604.54,"discounted_cash":604.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 GR"}]},{"description":"VENTOLIN HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00173068224","type":"NDC"}],"standard_charges":[{"gross_charge":147.05,"discounted_cash":147.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 GR"}]},{"description":"CLOTRIMAZOLE ANTI-FUNGAL 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126526","type":"NDC"}],"standard_charges":[{"gross_charge":32.7,"discounted_cash":32.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"GNP ATHLETES FOOT 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24385020503","type":"NDC"}],"standard_charges":[{"gross_charge":35.22,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"GNP ATHLETES FOOT 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24385020501","type":"NDC"}],"standard_charges":[{"gross_charge":28.43,"discounted_cash":28.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"ANTIFUNGAL (CLOTRIMAZOLE) 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68001047547","type":"NDC"}],"standard_charges":[{"gross_charge":36.68,"discounted_cash":36.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"GNP HYDROCORTISONE MAX ST 1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24385027603","type":"NDC"}],"standard_charges":[{"gross_charge":23.09,"discounted_cash":23.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006003","type":"NDC"}],"standard_charges":[{"gross_charge":24.72,"discounted_cash":24.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713028031","type":"NDC"}],"standard_charges":[{"gross_charge":26.0,"discounted_cash":26.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126328","type":"NDC"}],"standard_charges":[{"gross_charge":20.41,"discounted_cash":20.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006001","type":"NDC"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":17.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 GR"}]},{"description":"BACITRACIN 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536125628","type":"NDC"}],"standard_charges":[{"gross_charge":35.92,"discounted_cash":35.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672207501","type":"NDC"}],"standard_charges":[{"gross_charge":35.22,"discounted_cash":35.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"GNP DICLOFENAC SODIUM 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122075252","type":"NDC"}],"standard_charges":[{"gross_charge":79.94,"discounted_cash":79.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"GNP ARTHRITIS PAIN 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122064654","type":"NDC"}],"standard_charges":[{"gross_charge":91.52,"discounted_cash":91.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 GR"}]},{"description":"BACITRACIN ZINC 500 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672207502","type":"NDC"}],"standard_charges":[{"gross_charge":34.88,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"ICY HOT ADVANCED PAIN RELIEF 16-11 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"41167008016","type":"NDC"}],"standard_charges":[{"gross_charge":58.94,"discounted_cash":58.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 56 GR"}]},{"description":"HURRICAINE 20 % MT AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00283067902","type":"NDC"}],"standard_charges":[{"gross_charge":229.6,"discounted_cash":229.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"TOBRADEX 0.3-0.1 % OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00078087601","type":"NDC"}],"standard_charges":[{"gross_charge":847.44,"discounted_cash":847.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 GR"}]},{"description":"ANTACID/ANTIGAS 400-400-40 MG/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536131783","type":"NDC"}],"standard_charges":[{"gross_charge":3.05,"discounted_cash":3.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"GERI-LANTA 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896062912","type":"NDC"}],"standard_charges":[{"gross_charge":2.68,"discounted_cash":2.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"GERI-MOX 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896063912","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"GNP ANTACID & ANTI-GAS 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122043440","type":"NDC"}],"standard_charges":[{"gross_charge":8.44,"discounted_cash":8.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MINTOX MAXIMUM STRENGTH 400-400-40 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904572514","type":"NDC"}],"standard_charges":[{"gross_charge":5.77,"discounted_cash":5.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CYCLOMYDRIL 0.2-1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065035902","type":"NDC"}],"standard_charges":[{"gross_charge":227.85,"discounted_cash":227.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"INFANTS GAS RELIEF 20 MG/0.3ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69618005951","type":"NDC"}],"standard_charges":[{"gross_charge":3.53,"discounted_cash":3.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"SIMETHICONE DROPS INFANTS 20 MG/0.3ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536130375","type":"NDC"}],"standard_charges":[{"gross_charge":3.65,"discounted_cash":3.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"BETADINE 10 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67618015017","type":"NDC"}],"standard_charges":[{"gross_charge":6.03,"discounted_cash":6.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"BETADINE 5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67618016003","type":"NDC"}],"standard_charges":[{"gross_charge":78.06,"discounted_cash":78.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 88.7 ML"}]},{"description":"SALINE NASAL SPRAY 0.65 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802035758","type":"NDC"}],"standard_charges":[{"gross_charge":16.55,"discounted_cash":16.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"D-VITE PEDIATRIC 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71399740105","type":"NDC"}],"standard_charges":[{"gross_charge":4.65,"discounted_cash":4.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VITAMIN D INFANT 10 MCG/ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69618001959","type":"NDC"}],"standard_charges":[{"gross_charge":4.69,"discounted_cash":4.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE INTENSOL 1 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054317644","type":"NDC"}],"standard_charges":[{"gross_charge":40.47,"discounted_cash":40.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"XALATAN 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00013830304","type":"NDC"}],"standard_charges":[{"gross_charge":750.35,"discounted_cash":750.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65162067684","type":"NDC"}],"standard_charges":[{"gross_charge":79.8,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AZELASTINE HCL 137 MCG/SPRAY NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59651021430","type":"NDC"}],"standard_charges":[{"gross_charge":118.34,"discounted_cash":118.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"GNP FLUTICASONE PROPIONATE 50 MCG/ACT NA SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122068435","type":"NDC"}],"standard_charges":[{"gross_charge":80.15,"discounted_cash":80.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.1 ML"}]},{"description":"METHADONE HCL INTENSOL 10 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054355344","type":"NDC"}],"standard_charges":[{"gross_charge":12.96,"discounted_cash":12.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030615","type":"NDC"}],"standard_charges":[{"gross_charge":127.08,"discounted_cash":127.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69097014260","type":"NDC"}],"standard_charges":[{"gross_charge":105.87,"discounted_cash":105.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.7 GR"}]},{"description":"ESTRADIOL 0.1 MG/GM VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"66993000210","type":"NDC"}],"standard_charges":[{"gross_charge":443.45,"discounted_cash":443.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168016315","type":"NDC"}],"standard_charges":[{"gross_charge":106.23,"discounted_cash":106.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"MUPIROCIN 2 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"81033002050","type":"NDC"}],"standard_charges":[{"gross_charge":30.82,"discounted_cash":30.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"ALBUTEROL SULFATE HFA 108 (90 BASE) MCG/ACT IN AERS","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054074287","type":"NDC"}],"standard_charges":[{"gross_charge":31.65,"discounted_cash":31.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00168035755","type":"NDC"}],"standard_charges":[{"gross_charge":91.97,"discounted_cash":91.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"LIDOCAINE-PRILOCAINE 2.5-2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62332058204","type":"NDC"}],"standard_charges":[{"gross_charge":73.31,"discounted_cash":73.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 GR"}]},{"description":"MICRO GUARD 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"11701003816","type":"NDC"}],"standard_charges":[{"gross_charge":76.01,"discounted_cash":76.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 85 GR"}]},{"description":"DESENEX 2 % EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00316022515","type":"NDC"}],"standard_charges":[{"gross_charge":46.99,"discounted_cash":46.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 43 GR"}]},{"description":"VOLTAREN ARTHRITIS PAIN 1 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00067815203","type":"NDC"}],"standard_charges":[{"gross_charge":7.69,"discounted_cash":7.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 GR"}]},{"description":"PROCTOZONE-HC 2.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980032430","type":"NDC"}],"standard_charges":[{"gross_charge":76.47,"discounted_cash":76.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"PROCTOFOAM HC 1-1 % EX FOAM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00037682210","type":"NDC"}],"standard_charges":[{"gross_charge":858.16,"discounted_cash":858.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 GR"}]},{"description":"NITROGLYCERIN 0.4 MG/SPRAY TL SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"28595012049","type":"NDC"}],"standard_charges":[{"gross_charge":1093.76,"discounted_cash":1093.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 GR"}]},{"description":"EYE WASH OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536122497","type":"NDC"}],"standard_charges":[{"gross_charge":34.61,"discounted_cash":34.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60432046400","type":"NDC"}],"standard_charges":[{"gross_charge":11.79,"discounted_cash":11.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"BIOTENE DRY MOUTH MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"48582080220","type":"NDC"}],"standard_charges":[{"gross_charge":50.61,"discounted_cash":50.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 237 ML"}]},{"description":"AMOXICILLIN 400 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65862007150","type":"NDC"}],"standard_charges":[{"gross_charge":13.45,"discounted_cash":13.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.25 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00378827093","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020060","type":"NDC"}],"standard_charges":[{"gross_charge":6.69,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054350049","type":"NDC"}],"standard_charges":[{"gross_charge":12.24,"discounted_cash":12.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020001","type":"NDC"}],"standard_charges":[{"gross_charge":7.44,"discounted_cash":7.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42291007715","type":"NDC"}],"standard_charges":[{"gross_charge":33.41,"discounted_cash":33.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.1 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802005535","type":"NDC"}],"standard_charges":[{"gross_charge":30.91,"discounted_cash":30.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CAPSAICIN 0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536126456","type":"NDC"}],"standard_charges":[{"gross_charge":111.02,"discounted_cash":111.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42.5 GR"}]},{"description":"CLOTRIMAZOLE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672127502","type":"NDC"}],"standard_charges":[{"gross_charge":79.17,"discounted_cash":79.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"AYR SALINE NASAL NA GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225052547","type":"NDC"}],"standard_charges":[{"gross_charge":35.57,"discounted_cash":35.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.1 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"33342040530","type":"NDC"}],"standard_charges":[{"gross_charge":82.26,"discounted_cash":82.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOTRIMAZOLE-BETAMETHASONE 1-0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714049601","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":75.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"SILVER SULFADIAZINE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877012420","type":"NDC"}],"standard_charges":[{"gross_charge":96.16,"discounted_cash":96.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672125801","type":"NDC"}],"standard_charges":[{"gross_charge":115.65,"discounted_cash":115.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672125802","type":"NDC"}],"standard_charges":[{"gross_charge":94.23,"discounted_cash":94.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"LIDOCAINE 5 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64380078932","type":"NDC"}],"standard_charges":[{"gross_charge":109.91,"discounted_cash":109.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35.44 GR"}]},{"description":"KETOCONAZOLE 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672129802","type":"NDC"}],"standard_charges":[{"gross_charge":112.37,"discounted_cash":112.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180095601","type":"NDC"}],"standard_charges":[{"gross_charge":70.29,"discounted_cash":70.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"METRONIDAZOLE 0.75 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672411606","type":"NDC"}],"standard_charges":[{"gross_charge":110.13,"discounted_cash":110.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"ZINC OXIDE 20 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"75834017001","type":"NDC"}],"standard_charges":[{"gross_charge":64.49,"discounted_cash":64.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"CLOBETASOL PROPIONATE 0.05 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713065615","type":"NDC"}],"standard_charges":[{"gross_charge":44.8,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"TRIAMCINOLONE ACETONIDE 0.5 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802006535","type":"NDC"}],"standard_charges":[{"gross_charge":47.7,"discounted_cash":47.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68382037001","type":"NDC"}],"standard_charges":[{"gross_charge":85.15,"discounted_cash":85.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"FLUOCINONIDE 0.05 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672138601","type":"NDC"}],"standard_charges":[{"gross_charge":104.65,"discounted_cash":104.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"HYDROCORTISONE 1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672201301","type":"NDC"}],"standard_charges":[{"gross_charge":29.4,"discounted_cash":29.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.2 GR"}]},{"description":"NYSTATIN 100000 UNIT/GM EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802004811","type":"NDC"}],"standard_charges":[{"gross_charge":80.71,"discounted_cash":80.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"CALCIUM CARBONATE ANTACID 1250 MG/5ML (500 MG/5ML ELEMENTAL) PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121076616","type":"NDC"}],"standard_charges":[{"gross_charge":4.14,"discounted_cash":4.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.4 ML"}]},{"description":"NYSTATIN 100000 UNIT/GM EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00713067831","type":"NDC"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"FLEET ENEMA RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00132020140","type":"NDC"}],"standard_charges":[{"gross_charge":18.62,"discounted_cash":18.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"SUPREP BOWEL PREP KIT 17.5-3.13-1.6 GM/177ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"52268001201","type":"NDC"}],"standard_charges":[{"gross_charge":212.76,"discounted_cash":212.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208091019","type":"NDC"}],"standard_charges":[{"gross_charge":93.6,"discounted_cash":93.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200830","type":"NDC"}],"standard_charges":[{"gross_charge":86.12,"discounted_cash":86.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200802","type":"NDC"}],"standard_charges":[{"gross_charge":88.22,"discounted_cash":88.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 GR"}]},{"description":"SYMBICORT 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00186037028","type":"NDC"}],"standard_charges":[{"gross_charge":263.83,"discounted_cash":263.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 GR"}]},{"description":"SYMBICORT 160-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00186037020","type":"NDC"}],"standard_charges":[{"gross_charge":664.43,"discounted_cash":664.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.2 GR"}]},{"description":"SYMBICORT 80-4.5 MCG/ACT IN AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00186037228","type":"NDC"}],"standard_charges":[{"gross_charge":258.04,"discounted_cash":258.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.9 GR"}]},{"description":"NYAMYC 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00832046515","type":"NDC"}],"standard_charges":[{"gross_charge":121.64,"discounted_cash":121.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"NYSTOP 100000 UNIT/GM EX POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574200815","type":"NDC"}],"standard_charges":[{"gross_charge":56.39,"discounted_cash":56.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 GR"}]},{"description":"BAZA ANTIFUNGAL 2 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"11701004514","type":"NDC"}],"standard_charges":[{"gross_charge":61.2,"discounted_cash":61.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 142 GR"}]},{"description":"7 DAY VAGINAL 2 % VA CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672203506","type":"NDC"}],"standard_charges":[{"gross_charge":47.31,"discounted_cash":47.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 GR"}]},{"description":"NITRO-BID 2 % TD OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00281032608","type":"NDC"}],"standard_charges":[{"gross_charge":31.21,"discounted_cash":31.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"CALPROTECT 0.44-20.6 % EX OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69618006782","type":"NDC"}],"standard_charges":[{"gross_charge":53.62,"discounted_cash":53.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 GR"}]},{"description":"DESITIN DAILY DEFENSE 13 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"74300000301","type":"NDC"}],"standard_charges":[{"gross_charge":63.8,"discounted_cash":63.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 113 GR"}]},{"description":"HEMORRHOIDAL 0.25-14-74.9 % RE OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536128806","type":"NDC"}],"standard_charges":[{"gross_charge":35.82,"discounted_cash":35.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"GNP LIDOCAINE PAIN RELIEVING 4 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122061410","type":"NDC"}],"standard_charges":[{"gross_charge":37.18,"discounted_cash":37.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 76.5 GR"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71286601102","type":"NDC"}],"standard_charges":[{"gross_charge":25.59,"discounted_cash":25.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"INSULIN ASPART 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"73070010011","type":"NDC"}],"standard_charges":[{"gross_charge":19.16,"discounted_cash":19.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.08 ML"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"67877023022","type":"NDC"}],"standard_charges":[{"gross_charge":139.44,"discounted_cash":139.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.3 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"25021079002","type":"NDC"}],"standard_charges":[{"gross_charge":32.03,"discounted_cash":32.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MYCOPHENOLATE MOFETIL 200 MG/ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7517","type":"HCPCS"},{"code":"23155084851","type":"NDC"}],"standard_charges":[{"gross_charge":107.45,"discounted_cash":107.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"HUMULIN 70/30 (70-30) 100 UNIT/ML SC SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002871501","type":"NDC"}],"standard_charges":[{"gross_charge":31.77,"discounted_cash":31.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.68 ML"}]},{"description":"GASTROGRAFIN 66-10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00270044540","type":"NDC"}],"standard_charges":[{"gross_charge":25.82,"discounted_cash":25.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GASTROGRAFIN 66-10 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9963","type":"HCPCS"},{"code":"00270044535","type":"NDC"}],"standard_charges":[{"gross_charge":3.66,"discounted_cash":3.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HUMULIN R 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002821501","type":"NDC"}],"standard_charges":[{"gross_charge":13.46,"discounted_cash":13.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.03 ML"}]},{"description":"INSULIN GLARGINE-YFGN 100 UNIT/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"83257001411","type":"NDC"}],"standard_charges":[{"gross_charge":16.46,"discounted_cash":16.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.03 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896047208","type":"NDC"}],"standard_charges":[{"gross_charge":10.08,"discounted_cash":10.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DEXTROMETHORPHAN POLISTIREX ER 30 MG/5ML PO SUER","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802043321","type":"NDC"}],"standard_charges":[{"gross_charge":11.56,"discounted_cash":11.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121077516","type":"NDC"}],"standard_charges":[{"gross_charge":10.74,"discounted_cash":10.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"AMOXICILLIN-POT CLAVULANATE 400-57 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00781610446","type":"NDC"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":16.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.938 ML"}]},{"description":"DEEP SEA NASAL SPRAY 0.65 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904386575","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":15.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 44 ML"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141489","type":"NDC"}],"standard_charges":[{"gross_charge":18.1,"discounted_cash":18.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141490","type":"NDC"}],"standard_charges":[{"gross_charge":1.36,"discounted_cash":1.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.357 ML"}]},{"description":"ISOVUE-250 51 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131702","type":"NDC"}],"standard_charges":[{"gross_charge":0.42,"discounted_cash":0.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NICARDIPINE HCL IN NACL 20-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143963410","type":"NDC"}],"standard_charges":[{"gross_charge":202.46,"discounted_cash":202.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"08290306413","type":"NDC"}],"standard_charges":[{"gross_charge":15.58,"discounted_cash":15.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SODIUM BICARBONATE 8.4 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323008950","type":"NDC"}],"standard_charges":[{"gross_charge":14.95,"discounted_cash":14.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BUPIVACAINE-EPINEPHRINE (PF) 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409904201","type":"NDC"}],"standard_charges":[{"gross_charge":55.86,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM BICARBONATE 4.2 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"63323008305","type":"NDC"}],"standard_charges":[{"gross_charge":38.74,"discounted_cash":38.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"NITROPRUSSIDE SODIUM 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"14789001202","type":"NDC"}],"standard_charges":[{"gross_charge":449.83,"discounted_cash":449.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOXIFLOXACIN HCL-BSS 1 MG/ML IZ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"71449009642","type":"NDC"}],"standard_charges":[{"gross_charge":71.31,"discounted_cash":71.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.333 ML"}]},{"description":"MARCAINE/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00362055705","type":"NDC"}],"standard_charges":[{"gross_charge":73.08,"discounted_cash":73.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.4 ML"}]},{"description":"MARCAINE/EPINEPHRINE PF 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409174610","type":"NDC"}],"standard_charges":[{"gross_charge":36.95,"discounted_cash":36.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046238","type":"NDC"}],"standard_charges":[{"gross_charge":30.78,"discounted_cash":30.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MARCAINE/EPINEPHRINE PF 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409174910","type":"NDC"}],"standard_charges":[{"gross_charge":24.78,"discounted_cash":24.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046231","type":"NDC"}],"standard_charges":[{"gross_charge":52.8,"discounted_cash":52.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MARCAINE/EPINEPHRINE PF 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409174929","type":"NDC"}],"standard_charges":[{"gross_charge":69.16,"discounted_cash":69.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"00409488810","type":"NDC"}],"standard_charges":[{"gross_charge":21.57,"discounted_cash":21.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046217","type":"NDC"}],"standard_charges":[{"gross_charge":34.29,"discounted_cash":34.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046817","type":"NDC"}],"standard_charges":[{"gross_charge":37.13,"discounted_cash":37.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00264780009","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046837","type":"NDC"}],"standard_charges":[{"gross_charge":33.23,"discounted_cash":33.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"MARCAINE/EPINEPHRINE PF 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409174630","type":"NDC"}],"standard_charges":[{"gross_charge":25.22,"discounted_cash":25.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094076262","type":"NDC"}],"standard_charges":[{"gross_charge":26.27,"discounted_cash":26.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487020103","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00487020160","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204060001","type":"NDC"}],"standard_charges":[{"gross_charge":7.75,"discounted_cash":7.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487950101","type":"NDC"}],"standard_charges":[{"gross_charge":3.64,"discounted_cash":3.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SODIUM CHLORIDE 10 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378699889","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487980101","type":"NDC"}],"standard_charges":[{"gross_charge":8.21,"discounted_cash":8.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487900330","type":"NDC"}],"standard_charges":[{"gross_charge":12.22,"discounted_cash":12.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378797055","type":"NDC"}],"standard_charges":[{"gross_charge":7.12,"discounted_cash":7.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"SENSORCAINE-MPF/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046237","type":"NDC"}],"standard_charges":[{"gross_charge":33.69,"discounted_cash":33.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SODIUM CHLORIDE (PF) 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"63323018610","type":"NDC"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"08290306424","type":"NDC"}],"standard_charges":[{"gross_charge":22.59,"discounted_cash":22.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"63807050055","type":"NDC"}],"standard_charges":[{"gross_charge":14.47,"discounted_cash":14.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OPDIVO 40 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377211","type":"NDC"}],"standard_charges":[{"gross_charge":3269.04,"discounted_cash":3269.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"KEYTRUDA 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"00006302602","type":"NDC"}],"standard_charges":[{"gross_charge":37632.6,"discounted_cash":37632.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"OPDIVO 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003377412","type":"NDC"}],"standard_charges":[{"gross_charge":20107.55,"discounted_cash":20107.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KEYTRUDA 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9271","type":"HCPCS"},{"code":"00006302604","type":"NDC"}],"standard_charges":[{"gross_charge":37386.8,"discounted_cash":37386.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"DARZALEX 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050505","type":"NDC"}],"standard_charges":[{"gross_charge":7732.56,"discounted_cash":7732.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DARZALEX 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9145","type":"HCPCS"},{"code":"57894050520","type":"NDC"}],"standard_charges":[{"gross_charge":9871.68,"discounted_cash":9871.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ZYVOX 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"00009514004","type":"NDC"}],"standard_charges":[{"gross_charge":87.74,"discounted_cash":87.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"ZYVOX 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"00009780702","type":"NDC"}],"standard_charges":[{"gross_charge":87.74,"discounted_cash":87.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"FLUARIX 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"58160088452","type":"NDC"}],"standard_charges":[{"gross_charge":83.91,"discounted_cash":83.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLULAVAL 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90688","type":"HCPCS"},{"code":"19515081052","type":"NDC"}],"standard_charges":[{"gross_charge":92.58,"discounted_cash":92.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLUZONE 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"49281042450","type":"NDC"}],"standard_charges":[{"gross_charge":108.29,"discounted_cash":108.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FLUZONE HIGH-DOSE 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90662","type":"HCPCS"},{"code":"49281012465","type":"NDC"}],"standard_charges":[{"gross_charge":352.88,"discounted_cash":352.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378699789","type":"NDC"}],"standard_charges":[{"gross_charge":5.58,"discounted_cash":5.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"L.E.T. (RACEPINEPHRINE) 4-0.05-0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70092165844","type":"NDC"}],"standard_charges":[{"gross_charge":96.92,"discounted_cash":96.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"DONNATAL 16.2 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"66689006310","type":"NDC"}],"standard_charges":[{"gross_charge":288.12,"discounted_cash":288.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALUM & MAG HYDROXIDE-SIMETH 1200-1200-120 MG/30ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57237031631","type":"NDC"}],"standard_charges":[{"gross_charge":24.18,"discounted_cash":24.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204060060","type":"NDC"}],"standard_charges":[{"gross_charge":6.69,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204060030","type":"NDC"}],"standard_charges":[{"gross_charge":6.69,"discounted_cash":6.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204010001","type":"NDC"}],"standard_charges":[{"gross_charge":7.79,"discounted_cash":7.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"CARDENE IV 20-0.86 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066002610","type":"NDC"}],"standard_charges":[{"gross_charge":278.13,"discounted_cash":278.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"GARDASIL 9 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"00006412102","type":"NDC"}],"standard_charges":[{"gross_charge":977.19,"discounted_cash":977.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GARDASIL 9 0.5 ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"90651","type":"HCPCS"},{"code":"00006411903","type":"NDC"}],"standard_charges":[{"gross_charge":689.53,"discounted_cash":689.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CARDENE IV 40-0.83 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066001610","type":"NDC"}],"standard_charges":[{"gross_charge":429.66,"discounted_cash":429.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"CARDENE IV 40-0.83 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"43066002810","type":"NDC"}],"standard_charges":[{"gross_charge":597.56,"discounted_cash":597.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"RECK 123-0.25-0.04- 15 MG/50ML PERIARTICULA SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"70092143350","type":"NDC"}],"standard_charges":[{"gross_charge":63.28,"discounted_cash":63.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"64253022235","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00338004903","type":"NDC"}],"standard_charges":[{"gross_charge":72.94,"discounted_cash":72.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"00264180032","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":41.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HEPARIN NA (PORK) LOCK FLSH PF 10 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J1642","type":"HCPCS"},{"code":"08290306414","type":"NDC"}],"standard_charges":[{"gross_charge":18.79,"discounted_cash":18.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204010030","type":"NDC"}],"standard_charges":[{"gross_charge":6.91,"discounted_cash":6.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"SODIUM CHLORIDE 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204002260","type":"NDC"}],"standard_charges":[{"gross_charge":11.66,"discounted_cash":11.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687040583","type":"NDC"}],"standard_charges":[{"gross_charge":8.31,"discounted_cash":8.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63739016010","type":"NDC"}],"standard_charges":[{"gross_charge":13.39,"discounted_cash":13.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00641615125","type":"NDC"}],"standard_charges":[{"gross_charge":17.46,"discounted_cash":17.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"HYDROMORPHONE HCL PF 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"63323085325","type":"NDC"}],"standard_charges":[{"gross_charge":14.93,"discounted_cash":14.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00409131230","type":"NDC"}],"standard_charges":[{"gross_charge":23.13,"discounted_cash":23.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617510","type":"NDC"}],"standard_charges":[{"gross_charge":39.08,"discounted_cash":39.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 100 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037604","type":"NDC"}],"standard_charges":[{"gross_charge":32.67,"discounted_cash":32.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"INFED 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1750","type":"HCPCS"},{"code":"00023608210","type":"NDC"}],"standard_charges":[{"gross_charge":73.9,"discounted_cash":73.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DILAUDID 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"76045000906","type":"NDC"}],"standard_charges":[{"gross_charge":30.74,"discounted_cash":30.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DILAUDID 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045001011","type":"NDC"}],"standard_charges":[{"gross_charge":41.01,"discounted_cash":41.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEMEROL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00409117630","type":"NDC"}],"standard_charges":[{"gross_charge":45.95,"discounted_cash":45.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DEMEROL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00409136201","type":"NDC"}],"standard_charges":[{"gross_charge":38.31,"discounted_cash":38.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DEMEROL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00409141801","type":"NDC"}],"standard_charges":[{"gross_charge":40.25,"discounted_cash":40.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009307303","type":"NDC"}],"standard_charges":[{"gross_charge":41.46,"discounted_cash":41.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009307301","type":"NDC"}],"standard_charges":[{"gross_charge":29.09,"discounted_cash":29.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DEPO-MEDROL 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009347503","type":"NDC"}],"standard_charges":[{"gross_charge":46.67,"discounted_cash":46.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"CORVERT 1 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"00009379401","type":"NDC"}],"standard_charges":[{"gross_charge":449.26,"discounted_cash":449.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"16729052608","type":"NDC"}],"standard_charges":[{"gross_charge":41.64,"discounted_cash":41.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016516","type":"NDC"}],"standard_charges":[{"gross_charge":19.28,"discounted_cash":19.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016501","type":"NDC"}],"standard_charges":[{"gross_charge":15.84,"discounted_cash":15.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"OPDIVO 120 MG/12ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003375614","type":"NDC"}],"standard_charges":[{"gross_charge":11840.74,"discounted_cash":11840.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"AFLURIA PRESERVATIVE FREE 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90656","type":"HCPCS"},{"code":"33332002403","type":"NDC"}],"standard_charges":[{"gross_charge":86.75,"discounted_cash":86.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BEXSERO 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90620","type":"HCPCS"},{"code":"58160097620","type":"NDC"}],"standard_charges":[{"gross_charge":558.26,"discounted_cash":558.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VASOSTRICT 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023016410","type":"NDC"}],"standard_charges":[{"gross_charge":46.49,"discounted_cash":46.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ROBAXIN 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"00641610310","type":"NDC"}],"standard_charges":[{"gross_charge":49.38,"discounted_cash":49.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037701","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":79.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"63323037704","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":79.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 500 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617610","type":"NDC"}],"standard_charges":[{"gross_charge":66.18,"discounted_cash":66.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LEXISCAN 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00469650189","type":"NDC"}],"standard_charges":[{"gross_charge":647.0,"discounted_cash":647.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"RELISTOR 12 MG/0.6ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055102","type":"NDC"}],"standard_charges":[{"gross_charge":548.3,"discounted_cash":548.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"RELISTOR 12 MG/0.6ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055107","type":"NDC"}],"standard_charges":[{"gross_charge":548.3,"discounted_cash":548.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00409131236","type":"NDC"}],"standard_charges":[{"gross_charge":21.32,"discounted_cash":21.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"FLUCELVAX 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90661","type":"HCPCS"},{"code":"70461065403","type":"NDC"}],"standard_charges":[{"gross_charge":176.19,"discounted_cash":176.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00409336510","type":"NDC"}],"standard_charges":[{"gross_charge":14.88,"discounted_cash":14.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00641616901","type":"NDC"}],"standard_charges":[{"gross_charge":34.17,"discounted_cash":34.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE 10 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094000162","type":"NDC"}],"standard_charges":[{"gross_charge":31.08,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"VASOSTRICT 40-5 UT/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"42023021910","type":"NDC"}],"standard_charges":[{"gross_charge":488.62,"discounted_cash":488.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045401","type":"NDC"}],"standard_charges":[{"gross_charge":41.97,"discounted_cash":41.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612525","type":"NDC"}],"standard_charges":[{"gross_charge":18.56,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"MORPHINE SULFATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000511","type":"NDC"}],"standard_charges":[{"gross_charge":39.84,"discounted_cash":39.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189101","type":"NDC"}],"standard_charges":[{"gross_charge":28.99,"discounted_cash":28.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189001","type":"NDC"}],"standard_charges":[{"gross_charge":20.52,"discounted_cash":20.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"63323045201","type":"NDC"}],"standard_charges":[{"gross_charge":30.79,"discounted_cash":30.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE (PF) 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189023","type":"NDC"}],"standard_charges":[{"gross_charge":33.77,"discounted_cash":33.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2272","type":"HCPCS"},{"code":"76045000411","type":"NDC"}],"standard_charges":[{"gross_charge":31.53,"discounted_cash":31.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MORPHINE SULFATE-NACL 1-0.9 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092161379","type":"NDC"}],"standard_charges":[{"gross_charge":388.03,"discounted_cash":388.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MORPHINE SULFATE-NACL 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092138036","type":"NDC"}],"standard_charges":[{"gross_charge":106.11,"discounted_cash":106.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"70092141836","type":"NDC"}],"standard_charges":[{"gross_charge":363.79,"discounted_cash":363.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 100-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"44567061110","type":"NDC"}],"standard_charges":[{"gross_charge":250.54,"discounted_cash":250.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00409015224","type":"NDC"}],"standard_charges":[{"gross_charge":52.61,"discounted_cash":52.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00338105548","type":"NDC"}],"standard_charges":[{"gross_charge":45.09,"discounted_cash":45.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"00338954124","type":"NDC"}],"standard_charges":[{"gross_charge":38.94,"discounted_cash":38.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"47335099301","type":"NDC"}],"standard_charges":[{"gross_charge":59.94,"discounted_cash":59.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METRONIDAZOLE 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1836","type":"HCPCS"},{"code":"25021013182","type":"NDC"}],"standard_charges":[{"gross_charge":48.7,"discounted_cash":48.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71449000115","type":"NDC"}],"standard_charges":[{"gross_charge":17.96,"discounted_cash":17.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PHENYLEPHRINE HCL-NACL 1-0.9 MG/10ML-% IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70092104646","type":"NDC"}],"standard_charges":[{"gross_charge":18.85,"discounted_cash":18.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"73177010803","type":"NDC"}],"standard_charges":[{"gross_charge":34.56,"discounted_cash":34.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050616","type":"NDC"}],"standard_charges":[{"gross_charge":18.69,"discounted_cash":18.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323050601","type":"NDC"}],"standard_charges":[{"gross_charge":18.76,"discounted_cash":18.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"70069002125","type":"NDC"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":16.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150030425","type":"NDC"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":25.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"76045010910","type":"NDC"}],"standard_charges":[{"gross_charge":23.44,"discounted_cash":23.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409128331","type":"NDC"}],"standard_charges":[{"gross_charge":16.39,"discounted_cash":16.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00409128337","type":"NDC"}],"standard_charges":[{"gross_charge":28.9,"discounted_cash":28.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HYDROMORPHONE HCL 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00641620610","type":"NDC"}],"standard_charges":[{"gross_charge":44.65,"discounted_cash":44.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MENQUADFI 0.5 ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90734","type":"HCPCS"},{"code":"49281059005","type":"NDC"}],"standard_charges":[{"gross_charge":539.07,"discounted_cash":539.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BOOSTRIX 5-2.5-18.5 LF-MCG/0.5 IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"58160084252","type":"NDC"}],"standard_charges":[{"gross_charge":198.26,"discounted_cash":198.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PREVNAR 20 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"00005200002","type":"NDC"}],"standard_charges":[{"gross_charge":785.56,"discounted_cash":785.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121097440","type":"NDC"}],"standard_charges":[{"gross_charge":67.79,"discounted_cash":67.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687080017","type":"NDC"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":16.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VALPROIC ACID 250 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121135000","type":"NDC"}],"standard_charges":[{"gross_charge":29.84,"discounted_cash":29.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268074514","type":"NDC"}],"standard_charges":[{"gross_charge":54.54,"discounted_cash":54.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GUAIFENESIN-CODEINE 100-10 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121177540","type":"NDC"}],"standard_charges":[{"gross_charge":41.5,"discounted_cash":41.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301205","type":"NDC"}],"standard_charges":[{"gross_charge":64.11,"discounted_cash":64.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121482740","type":"NDC"}],"standard_charges":[{"gross_charge":59.86,"discounted_cash":59.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487020101","type":"NDC"}],"standard_charges":[{"gross_charge":8.5,"discounted_cash":8.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378967193","type":"NDC"}],"standard_charges":[{"gross_charge":9.99,"discounted_cash":9.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MINERAL OIL PO OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"48433020230","type":"NDC"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":10.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IPRATROPIUM-ALBUTEROL 0.5-2.5 MG/3ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"47335075652","type":"NDC"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00487950125","type":"NDC"}],"standard_charges":[{"gross_charge":7.19,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7613","type":"HCPCS"},{"code":"00487950103","type":"NDC"}],"standard_charges":[{"gross_charge":7.19,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"SODIUM CHLORIDE 0.9 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487930133","type":"NDC"}],"standard_charges":[{"gross_charge":7.19,"discounted_cash":7.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121115400","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.6 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687039483","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.02 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7644","type":"HCPCS"},{"code":"00487980130","type":"NDC"}],"standard_charges":[{"gross_charge":7.17,"discounted_cash":7.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/15ML (10%) PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687062807","type":"NDC"}],"standard_charges":[{"gross_charge":42.54,"discounted_cash":42.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687041771","type":"NDC"}],"standard_charges":[{"gross_charge":28.6,"discounted_cash":28.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121091400","type":"NDC"}],"standard_charges":[{"gross_charge":29.43,"discounted_cash":29.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094049461","type":"NDC"}],"standard_charges":[{"gross_charge":34.67,"discounted_cash":34.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MEGESTROL ACETATE 400 MG/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121094500","type":"NDC"}],"standard_charges":[{"gross_charge":11.89,"discounted_cash":11.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094004558","type":"NDC"}],"standard_charges":[{"gross_charge":65.36,"discounted_cash":65.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"PULMOZYME 2.5 MG/2.5ML IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50242010040","type":"NDC"}],"standard_charges":[{"gross_charge":801.44,"discounted_cash":801.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42192060845","type":"NDC"}],"standard_charges":[{"gross_charge":58.1,"discounted_cash":58.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"MAG-AL PLUS 200-200-20 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121176130","type":"NDC"}],"standard_charges":[{"gross_charge":12.87,"discounted_cash":12.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MAG-AL PLUS XS 400-400-40 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121176230","type":"NDC"}],"standard_charges":[{"gross_charge":17.63,"discounted_cash":17.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IBUPROFEN CHILDRENS 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094060061","type":"NDC"}],"standard_charges":[{"gross_charge":36.6,"discounted_cash":36.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GLYDO 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"25021067376","type":"NDC"}],"standard_charges":[{"gross_charge":57.86,"discounted_cash":57.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"SUCRALFATE 1 GM/10ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687073856","type":"NDC"}],"standard_charges":[{"gross_charge":52.06,"discounted_cash":52.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GLYDO 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"25021067377","type":"NDC"}],"standard_charges":[{"gross_charge":70.53,"discounted_cash":70.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121479950","type":"NDC"}],"standard_charges":[{"gross_charge":27.98,"discounted_cash":27.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990401","type":"NDC"}],"standard_charges":[{"gross_charge":11.69,"discounted_cash":11.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ISOVUE-M 300 61 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270141215","type":"NDC"}],"standard_charges":[{"gross_charge":5.65,"discounted_cash":5.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131635","type":"NDC"}],"standard_charges":[{"gross_charge":0.04,"discounted_cash":0.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.086 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131637","type":"NDC"}],"standard_charges":[{"gross_charge":36.24,"discounted_cash":36.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CYSTOGRAFIN-DILUTE 18 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270141030","type":"NDC"}],"standard_charges":[{"gross_charge":2.22,"discounted_cash":2.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROHANCE 279.3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9579","type":"HCPCS"},{"code":"00270111101","type":"NDC"}],"standard_charges":[{"gross_charge":144.98,"discounted_cash":144.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"OMNIPAQUE 180 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9965","type":"HCPCS"},{"code":"00407141110","type":"NDC"}],"standard_charges":[{"gross_charge":16.54,"discounted_cash":16.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OMNIPAQUE 350 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141493","type":"NDC"}],"standard_charges":[{"gross_charge":288.11,"discounted_cash":288.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141210","type":"NDC"}],"standard_charges":[{"gross_charge":17.99,"discounted_cash":17.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141220","type":"NDC"}],"standard_charges":[{"gross_charge":18.98,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222321","type":"NDC"}],"standard_charges":[{"gross_charge":157.64,"discounted_cash":157.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222317","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222316","type":"NDC"}],"standard_charges":[{"gross_charge":7.25,"discounted_cash":7.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VISIPAQUE 320 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407222319","type":"NDC"}],"standard_charges":[{"gross_charge":36.24,"discounted_cash":36.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141363","type":"NDC"}],"standard_charges":[{"gross_charge":2.82,"discounted_cash":2.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141361","type":"NDC"}],"standard_charges":[{"gross_charge":3.83,"discounted_cash":3.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OMNIPAQUE 300 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00407141359","type":"NDC"}],"standard_charges":[{"gross_charge":11.46,"discounted_cash":11.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OMNIPAQUE 240 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407141230","type":"NDC"}],"standard_charges":[{"gross_charge":1.62,"discounted_cash":1.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222216","type":"NDC"}],"standard_charges":[{"gross_charge":21.74,"discounted_cash":21.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222219","type":"NDC"}],"standard_charges":[{"gross_charge":184.87,"discounted_cash":184.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 110 ML"}]},{"description":"VISIPAQUE 270 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9966","type":"HCPCS"},{"code":"00407222217","type":"NDC"}],"standard_charges":[{"gross_charge":85.71,"discounted_cash":85.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 55 ML"}]},{"description":"OMNIPAQUE 12 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"00407141612","type":"NDC"}],"standard_charges":[{"gross_charge":1.82,"discounted_cash":1.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17.5 ML"}]},{"description":"DOTAREM 2.5 MMOL/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200100","type":"NDC"}],"standard_charges":[{"gross_charge":20.63,"discounted_cash":20.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DOTAREM 2.5 MMOL/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200000","type":"NDC"}],"standard_charges":[{"gross_charge":2.2,"discounted_cash":2.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 ML"}]},{"description":"VALPROIC ACID 250 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121467500","type":"NDC"}],"standard_charges":[{"gross_charge":18.46,"discounted_cash":18.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094004962","type":"NDC"}],"standard_charges":[{"gross_charge":38.81,"discounted_cash":38.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GABAPENTIN 300 MG/6ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42192060840","type":"NDC"}],"standard_charges":[{"gross_charge":16.37,"discounted_cash":16.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121053005","type":"NDC"}],"standard_charges":[{"gross_charge":28.62,"discounted_cash":28.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.667 ML"}]},{"description":"ACETAMINOPHEN 160 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"81033000250","type":"NDC"}],"standard_charges":[{"gross_charge":42.2,"discounted_cash":42.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20.313 ML"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQUID UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121148800","type":"NDC"}],"standard_charges":[{"gross_charge":14.13,"discounted_cash":14.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904726594","type":"NDC"}],"standard_charges":[{"gross_charge":55.61,"discounted_cash":55.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GNP ANTACID REGULAR STRENGTH 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122043340","type":"NDC"}],"standard_charges":[{"gross_charge":4.83,"discounted_cash":4.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SODIUM CHLORIDE 7 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487900730","type":"NDC"}],"standard_charges":[{"gross_charge":20.35,"discounted_cash":20.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328012050","type":"NDC"}],"standard_charges":[{"gross_charge":37.57,"discounted_cash":37.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"STERILE TOPICAL L.E.T. GEL 4-0.18-0.5 % EX GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71266629001","type":"NDC"}],"standard_charges":[{"gross_charge":123.69,"discounted_cash":123.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MILK OF MAGNESIA 7.75 % PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121043130","type":"NDC"}],"standard_charges":[{"gross_charge":8.59,"discounted_cash":8.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MILK OF MAGNESIA 2400 MG/30ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63739019610","type":"NDC"}],"standard_charges":[{"gross_charge":36.81,"discounted_cash":36.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MILK OF MAGNESIA 2400 MG/30ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015317","type":"NDC"}],"standard_charges":[{"gross_charge":22.66,"discounted_cash":22.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MILK OF MAGNESIA 400 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687042976","type":"NDC"}],"standard_charges":[{"gross_charge":9.06,"discounted_cash":9.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PERFOROMIST 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"49502060561","type":"NDC"}],"standard_charges":[{"gross_charge":63.41,"discounted_cash":63.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PERFOROMIST 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"49502060530","type":"NDC"}],"standard_charges":[{"gross_charge":62.77,"discounted_cash":62.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SPS (SODIUM POLYSTYRENE SULF) 15 GM/60ML CO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46287000660","type":"NDC"}],"standard_charges":[{"gross_charge":198.44,"discounted_cash":198.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 60 ML"}]},{"description":"MILK OF MAGNESIA CONCENTRATE 2400 MG/10ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121094000","type":"NDC"}],"standard_charges":[{"gross_charge":26.53,"discounted_cash":26.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015217","type":"NDC"}],"standard_charges":[{"gross_charge":27.49,"discounted_cash":27.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015219","type":"NDC"}],"standard_charges":[{"gross_charge":12.71,"discounted_cash":12.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"OPDUALAG 240-80 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9298","type":"HCPCS"},{"code":"00003712511","type":"NDC"}],"standard_charges":[{"gross_charge":96427.54,"discounted_cash":96427.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"MORPHINE SULFATE (PF) 4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189123","type":"NDC"}],"standard_charges":[{"gross_charge":48.44,"discounted_cash":48.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPRIVAN 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026929","type":"NDC"}],"standard_charges":[{"gross_charge":12.86,"discounted_cash":12.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DIPRIVAN 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026994","type":"NDC"}],"standard_charges":[{"gross_charge":14.64,"discounted_cash":14.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIPRIVAN 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026959","type":"NDC"}],"standard_charges":[{"gross_charge":73.39,"discounted_cash":73.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 49.28 ML"}]},{"description":"DIPRIVAN 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026969","type":"NDC"}],"standard_charges":[{"gross_charge":14.95,"discounted_cash":14.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.152 ML"}]},{"description":"DIPRIVAN 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026965","type":"NDC"}],"standard_charges":[{"gross_charge":135.19,"discounted_cash":135.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 99.225 ML"}]},{"description":"DIPRIVAN 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"63323026950","type":"NDC"}],"standard_charges":[{"gross_charge":73.31,"discounted_cash":73.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 49.215 ML"}]},{"description":"RIABNI 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513032601","type":"NDC"}],"standard_charges":[{"gross_charge":8434.03,"discounted_cash":8434.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"JEMPERLI 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9272","type":"HCPCS"},{"code":"00173089803","type":"NDC"}],"standard_charges":[{"gross_charge":36702.82,"discounted_cash":36702.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"RYBREVANT 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9061","type":"HCPCS"},{"code":"57894050101","type":"NDC"}],"standard_charges":[{"gross_charge":34159.53,"discounted_cash":34159.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 21 ML"}]},{"description":"ZYNRELEF 200-6 MG/7ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9088","type":"HCPCS"},{"code":"47426030301","type":"NDC"}],"standard_charges":[{"gross_charge":372.48,"discounted_cash":372.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.5 ML"}]},{"description":"ZYNRELEF 400-12 MG/14ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9088","type":"HCPCS"},{"code":"47426030102","type":"NDC"}],"standard_charges":[{"gross_charge":483.36,"discounted_cash":483.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"00143987525","type":"NDC"}],"standard_charges":[{"gross_charge":28.3,"discounted_cash":28.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015303","type":"NDC"}],"standard_charges":[{"gross_charge":51.41,"discounted_cash":51.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061603","type":"NDC"}],"standard_charges":[{"gross_charge":44.57,"discounted_cash":44.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"AMIODARONE HCL 150 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"00143987510","type":"NDC"}],"standard_charges":[{"gross_charge":38.37,"discounted_cash":38.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"PREVNAR 20 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90677","type":"HCPCS"},{"code":"00005200010","type":"NDC"}],"standard_charges":[{"gross_charge":760.58,"discounted_cash":760.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"81033000230","type":"NDC"}],"standard_charges":[{"gross_charge":17.22,"discounted_cash":17.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.156 ML"}]},{"description":"AMANTADINE HCL 50 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121064610","type":"NDC"}],"standard_charges":[{"gross_charge":47.09,"discounted_cash":47.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ACETAMINOPHEN 650 MG/20.3ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687074037","type":"NDC"}],"standard_charges":[{"gross_charge":13.5,"discounted_cash":13.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.95 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63739097610","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121495040","type":"NDC"}],"standard_charges":[{"gross_charge":31.41,"discounted_cash":31.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"METHADONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094003162","type":"NDC"}],"standard_charges":[{"gross_charge":59.23,"discounted_cash":59.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69339015717","type":"NDC"}],"standard_charges":[{"gross_charge":38.09,"discounted_cash":38.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328015705","type":"NDC"}],"standard_charges":[{"gross_charge":48.33,"discounted_cash":48.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204090001","type":"NDC"}],"standard_charges":[{"gross_charge":22.14,"discounted_cash":22.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HYDROCODONE-ACETAMINOPHEN 7.5-325 MG/15ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121231650","type":"NDC"}],"standard_charges":[{"gross_charge":39.78,"discounted_cash":39.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GUAIFENESIN-CODEINE 200-20 MG/10ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121155040","type":"NDC"}],"standard_charges":[{"gross_charge":51.78,"discounted_cash":51.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIAZEPAM 5 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121090594","type":"NDC"}],"standard_charges":[{"gross_charge":65.72,"discounted_cash":65.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GUAIFENESIN-DM 100-10 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121127600","type":"NDC"}],"standard_charges":[{"gross_charge":16.26,"discounted_cash":16.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SENNA 8.8 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"48433021940","type":"NDC"}],"standard_charges":[{"gross_charge":43.09,"discounted_cash":43.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"GUAIFENESIN 100 MG/5ML PO LIQUID UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121174400","type":"NDC"}],"standard_charges":[{"gross_charge":21.01,"discounted_cash":21.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NYSTATIN 100000 UNIT/ML MT SUSP BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121086850","type":"NDC"}],"standard_charges":[{"gross_charge":23.49,"discounted_cash":23.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FERROUS SULFATE 300 (60 FE) MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268033624","type":"NDC"}],"standard_charges":[{"gross_charge":41.02,"discounted_cash":41.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUTEROL SULFATE 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990425","type":"NDC"}],"standard_charges":[{"gross_charge":18.91,"discounted_cash":18.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"SODIUM CITRATE-CITRIC ACID 500-334 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121119000","type":"NDC"}],"standard_charges":[{"gross_charge":59.51,"discounted_cash":59.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MEGESTROL ACETATE 40 MG/ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094006362","type":"NDC"}],"standard_charges":[{"gross_charge":9.82,"discounted_cash":9.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GUAIFENESIN-DM 100-10 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121063800","type":"NDC"}],"standard_charges":[{"gross_charge":20.04,"discounted_cash":20.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ONDANSETRON HCL 4 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687025286","type":"NDC"}],"standard_charges":[{"gross_charge":92.45,"discounted_cash":92.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687024977","type":"NDC"}],"standard_charges":[{"gross_charge":61.89,"discounted_cash":61.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68094076462","type":"NDC"}],"standard_charges":[{"gross_charge":100.54,"discounted_cash":100.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70748026130","type":"NDC"}],"standard_charges":[{"gross_charge":50.98,"discounted_cash":50.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70748026160","type":"NDC"}],"standard_charges":[{"gross_charge":50.73,"discounted_cash":50.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756060870","type":"NDC"}],"standard_charges":[{"gross_charge":77.08,"discounted_cash":77.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687057686","type":"NDC"}],"standard_charges":[{"gross_charge":19.03,"discounted_cash":19.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OXYCODONE HCL 5 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121482750","type":"NDC"}],"standard_charges":[{"gross_charge":56.41,"discounted_cash":56.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FORMOTEROL FUMARATE 20 MCG/2ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7606","type":"HCPCS"},{"code":"00378163193","type":"NDC"}],"standard_charges":[{"gross_charge":73.69,"discounted_cash":73.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121048900","type":"NDC"}],"standard_charges":[{"gross_charge":35.82,"discounted_cash":35.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"SULFAMETHOXAZOLE-TRIMETHOPRIM 200-40 MG/5ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121085340","type":"NDC"}],"standard_charges":[{"gross_charge":61.12,"discounted_cash":61.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904727972","type":"NDC"}],"standard_charges":[{"gross_charge":5.59,"discounted_cash":5.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOCUSATE SODIUM 100 MG/10ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121187000","type":"NDC"}],"standard_charges":[{"gross_charge":7.65,"discounted_cash":7.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NICARDIPINE HCL IN NACL 40-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143963310","type":"NDC"}],"standard_charges":[{"gross_charge":18.9,"discounted_cash":18.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ANTACID REGULAR STRENGTH 200-200-20 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536129383","type":"NDC"}],"standard_charges":[{"gross_charge":9.43,"discounted_cash":9.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"EYE DROPS 0.05 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536121794","type":"NDC"}],"standard_charges":[{"gross_charge":19.89,"discounted_cash":19.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"72266025301","type":"NDC"}],"standard_charges":[{"gross_charge":346.07,"discounted_cash":346.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018922","type":"NDC"}],"standard_charges":[{"gross_charge":143.63,"discounted_cash":143.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13.5 ML"}]},{"description":"CISPLATIN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"25021025350","type":"NDC"}],"standard_charges":[{"gross_charge":301.87,"discounted_cash":301.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 34 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641614610","type":"NDC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":12.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.063 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219057210","type":"NDC"}],"standard_charges":[{"gross_charge":27.77,"discounted_cash":27.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011751","type":"NDC"}],"standard_charges":[{"gross_charge":88.4,"discounted_cash":88.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042130","type":"NDC"}],"standard_charges":[{"gross_charge":29.53,"discounted_cash":29.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"72266010201","type":"NDC"}],"standard_charges":[{"gross_charge":19.19,"discounted_cash":19.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"25021020751","type":"NDC"}],"standard_charges":[{"gross_charge":132.67,"discounted_cash":132.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18.5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69918070025","type":"NDC"}],"standard_charges":[{"gross_charge":33.92,"discounted_cash":33.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036061","type":"NDC"}],"standard_charges":[{"gross_charge":69.82,"discounted_cash":69.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042254","type":"NDC"}],"standard_charges":[{"gross_charge":16.53,"discounted_cash":16.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"00703321801","type":"NDC"}],"standard_charges":[{"gross_charge":123.32,"discounted_cash":123.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"00641600710","type":"NDC"}],"standard_charges":[{"gross_charge":33.39,"discounted_cash":33.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"67457047322","type":"NDC"}],"standard_charges":[{"gross_charge":42.79,"discounted_cash":42.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021598","type":"NDC"}],"standard_charges":[{"gross_charge":76.47,"discounted_cash":76.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.5 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"70069080610","type":"NDC"}],"standard_charges":[{"gross_charge":34.68,"discounted_cash":34.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"00703423901","type":"NDC"}],"standard_charges":[{"gross_charge":97.14,"discounted_cash":97.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 100 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042010","type":"NDC"}],"standard_charges":[{"gross_charge":20.85,"discounted_cash":20.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010365","type":"NDC"}],"standard_charges":[{"gross_charge":244.97,"discounted_cash":244.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"CISPLATIN 50 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729028811","type":"NDC"}],"standard_charges":[{"gross_charge":59.62,"discounted_cash":59.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"68462047054","type":"NDC"}],"standard_charges":[{"gross_charge":29.43,"discounted_cash":29.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"25021025351","type":"NDC"}],"standard_charges":[{"gross_charge":275.48,"discounted_cash":275.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 43 ML"}]},{"description":"CISPLATIN 200 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"63323010364","type":"NDC"}],"standard_charges":[{"gross_charge":226.26,"discounted_cash":226.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"62332075150","type":"NDC"}],"standard_charges":[{"gross_charge":365.34,"discounted_cash":365.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"72205026507","type":"NDC"}],"standard_charges":[{"gross_charge":37.56,"discounted_cash":37.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"36000024425","type":"NDC"}],"standard_charges":[{"gross_charge":30.92,"discounted_cash":30.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041125","type":"NDC"}],"standard_charges":[{"gross_charge":18.39,"discounted_cash":18.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MIDAZOLAM HCL 50 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641606010","type":"NDC"}],"standard_charges":[{"gross_charge":57.17,"discounted_cash":57.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054011","type":"NDC"}],"standard_charges":[{"gross_charge":25.27,"discounted_cash":25.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020110","type":"NDC"}],"standard_charges":[{"gross_charge":18.03,"discounted_cash":18.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016530","type":"NDC"}],"standard_charges":[{"gross_charge":22.82,"discounted_cash":22.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"00548960200","type":"NDC"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"72603013925","type":"NDC"}],"standard_charges":[{"gross_charge":71.76,"discounted_cash":71.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323026201","type":"NDC"}],"standard_charges":[{"gross_charge":33.52,"discounted_cash":33.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641620825","type":"NDC"}],"standard_charges":[{"gross_charge":21.19,"discounted_cash":21.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054001","type":"NDC"}],"standard_charges":[{"gross_charge":41.92,"discounted_cash":41.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714015001","type":"NDC"}],"standard_charges":[{"gross_charge":39.44,"discounted_cash":39.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"62332062250","type":"NDC"}],"standard_charges":[{"gross_charge":414.84,"discounted_cash":414.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00641613225","type":"NDC"}],"standard_charges":[{"gross_charge":38.42,"discounted_cash":38.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VINBLASTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9360","type":"HCPCS"},{"code":"63323027810","type":"NDC"}],"standard_charges":[{"gross_charge":520.94,"discounted_cash":520.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.4 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"65219029510","type":"NDC"}],"standard_charges":[{"gross_charge":278.38,"discounted_cash":278.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.8 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"69097080232","type":"NDC"}],"standard_charges":[{"gross_charge":74.34,"discounted_cash":74.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"63323076350","type":"NDC"}],"standard_charges":[{"gross_charge":132.63,"discounted_cash":132.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918090110","type":"NDC"}],"standard_charges":[{"gross_charge":394.6,"discounted_cash":394.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.8 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041625","type":"NDC"}],"standard_charges":[{"gross_charge":168.25,"discounted_cash":168.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"50227103005","type":"NDC"}],"standard_charges":[{"gross_charge":217.52,"discounted_cash":217.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"55150037025","type":"NDC"}],"standard_charges":[{"gross_charge":159.97,"discounted_cash":159.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"42023012989","type":"NDC"}],"standard_charges":[{"gross_charge":44.05,"discounted_cash":44.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"67457078108","type":"NDC"}],"standard_charges":[{"gross_charge":200.56,"discounted_cash":200.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.1 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918090112","type":"NDC"}],"standard_charges":[{"gross_charge":61.54,"discounted_cash":61.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"00517400225","type":"NDC"}],"standard_charges":[{"gross_charge":72.43,"discounted_cash":72.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069078325","type":"NDC"}],"standard_charges":[{"gross_charge":38.19,"discounted_cash":38.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"25021021599","type":"NDC"}],"standard_charges":[{"gross_charge":59.01,"discounted_cash":59.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9.8 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143932910","type":"NDC"}],"standard_charges":[{"gross_charge":13.75,"discounted_cash":13.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116301","type":"NDC"}],"standard_charges":[{"gross_charge":12.64,"discounted_cash":12.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.28 ML"}]},{"description":"BUPIVACAINE HCL 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150025050","type":"NDC"}],"standard_charges":[{"gross_charge":13.94,"discounted_cash":13.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00143957710","type":"NDC"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025220","type":"NDC"}],"standard_charges":[{"gross_charge":28.69,"discounted_cash":28.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040211","type":"NDC"}],"standard_charges":[{"gross_charge":14.18,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 15 MG/5ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7510","type":"HCPCS"},{"code":"00121075908","type":"NDC"}],"standard_charges":[{"gross_charge":40.74,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041112","type":"NDC"}],"standard_charges":[{"gross_charge":15.38,"discounted_cash":15.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040201","type":"NDC"}],"standard_charges":[{"gross_charge":18.56,"discounted_cash":18.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.42 ML"}]},{"description":"MIDAZOLAM HCL 50 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409259605","type":"NDC"}],"standard_charges":[{"gross_charge":136.38,"discounted_cash":136.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040266","type":"NDC"}],"standard_charges":[{"gross_charge":27.05,"discounted_cash":27.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"QUELICIN 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"00409662902","type":"NDC"}],"standard_charges":[{"gross_charge":22.53,"discounted_cash":22.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"THIAMINE HCL 200 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"43598005025","type":"NDC"}],"standard_charges":[{"gross_charge":39.87,"discounted_cash":39.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028561","type":"NDC"}],"standard_charges":[{"gross_charge":141.64,"discounted_cash":141.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"EPOGEN 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513047810","type":"NDC"}],"standard_charges":[{"gross_charge":1114.1,"discounted_cash":1114.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROCRIT 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676032004","type":"NDC"}],"standard_charges":[{"gross_charge":547.18,"discounted_cash":547.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"00703424801","type":"NDC"}],"standard_charges":[{"gross_charge":31.45,"discounted_cash":31.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"FLUOROURACIL 2.5 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018822","type":"NDC"}],"standard_charges":[{"gross_charge":161.43,"discounted_cash":161.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13.5 ML"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"44567040010","type":"NDC"}],"standard_charges":[{"gross_charge":66.7,"discounted_cash":66.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MORPHINE SULFATE POWD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"38779067307","type":"NDC"}],"standard_charges":[{"gross_charge":60.35,"discounted_cash":60.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.04 GR"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116001","type":"NDC"}],"standard_charges":[{"gross_charge":13.02,"discounted_cash":13.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427702","type":"NDC"}],"standard_charges":[{"gross_charge":13.38,"discounted_cash":13.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00143932001","type":"NDC"}],"standard_charges":[{"gross_charge":13.12,"discounted_cash":13.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00143962301","type":"NDC"}],"standard_charges":[{"gross_charge":42.73,"discounted_cash":42.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409318201","type":"NDC"}],"standard_charges":[{"gross_charge":14.28,"discounted_cash":14.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016526","type":"NDC"}],"standard_charges":[{"gross_charge":15.53,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427701","type":"NDC"}],"standard_charges":[{"gross_charge":13.57,"discounted_cash":13.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"00338604648","type":"NDC"}],"standard_charges":[{"gross_charge":73.83,"discounted_cash":73.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00143962201","type":"NDC"}],"standard_charges":[{"gross_charge":13.3,"discounted_cash":13.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025110","type":"NDC"}],"standard_charges":[{"gross_charge":13.29,"discounted_cash":13.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71288071911","type":"NDC"}],"standard_charges":[{"gross_charge":21.66,"discounted_cash":21.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641605725","type":"NDC"}],"standard_charges":[{"gross_charge":13.97,"discounted_cash":13.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641620925","type":"NDC"}],"standard_charges":[{"gross_charge":13.97,"discounted_cash":13.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 120 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"55150023930","type":"NDC"}],"standard_charges":[{"gross_charge":16.5,"discounted_cash":16.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427602","type":"NDC"}],"standard_charges":[{"gross_charge":12.97,"discounted_cash":12.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"ONDANSETRON HCL 40 MG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409475901","type":"NDC"}],"standard_charges":[{"gross_charge":15.51,"discounted_cash":15.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338361224","type":"NDC"}],"standard_charges":[{"gross_charge":56.14,"discounted_cash":56.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338381424","type":"NDC"}],"standard_charges":[{"gross_charge":77.84,"discounted_cash":77.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 33.333 ML"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150025410","type":"NDC"}],"standard_charges":[{"gross_charge":14.12,"discounted_cash":14.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641605910","type":"NDC"}],"standard_charges":[{"gross_charge":13.51,"discounted_cash":13.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ANECTINE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"00781341195","type":"NDC"}],"standard_charges":[{"gross_charge":36.62,"discounted_cash":36.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054201","type":"NDC"}],"standard_charges":[{"gross_charge":18.98,"discounted_cash":18.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"44206025110","type":"NDC"}],"standard_charges":[{"gross_charge":124.97,"discounted_cash":124.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 24 ML"}]},{"description":"KENALOG-40 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003029328","type":"NDC"}],"standard_charges":[{"gross_charge":41.65,"discounted_cash":41.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"00143951001","type":"NDC"}],"standard_charges":[{"gross_charge":123.4,"discounted_cash":123.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.2 ML"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"63323047401","type":"NDC"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011431","type":"NDC"}],"standard_charges":[{"gross_charge":258.27,"discounted_cash":258.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.9 ML"}]},{"description":"FLUPHENAZINE DECANOATE 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2680","type":"HCPCS"},{"code":"00143952901","type":"NDC"}],"standard_charges":[{"gross_charge":49.25,"discounted_cash":49.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"25021050201","type":"NDC"}],"standard_charges":[{"gross_charge":30.32,"discounted_cash":30.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001020","type":"NDC"}],"standard_charges":[{"gross_charge":40.34,"discounted_cash":40.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"61703034250","type":"NDC"}],"standard_charges":[{"gross_charge":54.92,"discounted_cash":54.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"55150040325","type":"NDC"}],"standard_charges":[{"gross_charge":39.29,"discounted_cash":39.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"81952011106","type":"NDC"}],"standard_charges":[{"gross_charge":34.1,"discounted_cash":34.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155052341","type":"NDC"}],"standard_charges":[{"gross_charge":25.87,"discounted_cash":25.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ETOPOSIDE 1 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011411","type":"NDC"}],"standard_charges":[{"gross_charge":285.52,"discounted_cash":285.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.6 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155029441","type":"NDC"}],"standard_charges":[{"gross_charge":30.76,"discounted_cash":30.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PACLITAXEL 150 MG/25ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"00703321701","type":"NDC"}],"standard_charges":[{"gross_charge":1075.56,"discounted_cash":1075.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 42 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"23155029442","type":"NDC"}],"standard_charges":[{"gross_charge":46.56,"discounted_cash":46.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121116801","type":"NDC"}],"standard_charges":[{"gross_charge":53.61,"discounted_cash":53.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"00641613525","type":"NDC"}],"standard_charges":[{"gross_charge":39.18,"discounted_cash":39.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"63323018410","type":"NDC"}],"standard_charges":[{"gross_charge":22.15,"discounted_cash":22.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"43598066625","type":"NDC"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001094","type":"NDC"}],"standard_charges":[{"gross_charge":24.74,"discounted_cash":24.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"67457038599","type":"NDC"}],"standard_charges":[{"gross_charge":32.49,"discounted_cash":32.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"KENALOG-10 10 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003049420","type":"NDC"}],"standard_charges":[{"gross_charge":39.48,"discounted_cash":39.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ALBURX 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031025","type":"NDC"}],"standard_charges":[{"gross_charge":257.44,"discounted_cash":257.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBURX 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"44206031050","type":"NDC"}],"standard_charges":[{"gross_charge":279.87,"discounted_cash":279.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"CELESTONE SOLUSPAN 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"78206011801","type":"NDC"}],"standard_charges":[{"gross_charge":69.98,"discounted_cash":69.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MIACALCIN 200 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0630","type":"HCPCS"},{"code":"67457067502","type":"NDC"}],"standard_charges":[{"gross_charge":1247.58,"discounted_cash":1247.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DDAVP 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"55566230000","type":"NDC"}],"standard_charges":[{"gross_charge":814.85,"discounted_cash":814.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"EPOGEN 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513028310","type":"NDC"}],"standard_charges":[{"gross_charge":830.42,"discounted_cash":830.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"HUMULIN R 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002021301","type":"NDC"}],"standard_charges":[{"gross_charge":13.43,"discounted_cash":13.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.03 ML"}]},{"description":"KENALOG-40 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003029320","type":"NDC"}],"standard_charges":[{"gross_charge":75.07,"discounted_cash":75.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ALBUMINEX 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"64208251203","type":"NDC"}],"standard_charges":[{"gross_charge":206.69,"discounted_cash":206.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317803","type":"NDC"}],"standard_charges":[{"gross_charge":15.25,"discounted_cash":15.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"GEMCITABINE HCL 200 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9196","type":"HCPCS"},{"code":"16729039130","type":"NDC"}],"standard_charges":[{"gross_charge":460.5,"discounted_cash":460.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"25021046110","type":"NDC"}],"standard_charges":[{"gross_charge":441.78,"discounted_cash":441.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.4 ML"}]},{"description":"DOCETAXEL 160 MG/8ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"16729026765","type":"NDC"}],"standard_charges":[{"gross_charge":669.79,"discounted_cash":669.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.475 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714014001","type":"NDC"}],"standard_charges":[{"gross_charge":76.52,"discounted_cash":76.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 UN"}]},{"description":"RETACRIT 20000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069131110","type":"NDC"}],"standard_charges":[{"gross_charge":449.19,"discounted_cash":449.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.7 ML"}]},{"description":"EPINEPHRINE 30 MG/30ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329906000","type":"NDC"}],"standard_charges":[{"gross_charge":36.63,"discounted_cash":36.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"PROCAINAMIDE HCL 500 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2690","type":"HCPCS"},{"code":"14789090002","type":"NDC"}],"standard_charges":[{"gross_charge":1811.17,"discounted_cash":1811.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DOCETAXEL 80 MG/4ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9171","type":"HCPCS"},{"code":"00409036701","type":"NDC"}],"standard_charges":[{"gross_charge":303.1,"discounted_cash":303.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.1 ML"}]},{"description":"BETAMETHASONE SOD PHOS & ACET 6 (3-3) MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0702","type":"HCPCS"},{"code":"00517072001","type":"NDC"}],"standard_charges":[{"gross_charge":25.73,"discounted_cash":25.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.083 ML"}]},{"description":"METHADONE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1230","type":"HCPCS"},{"code":"67457021720","type":"NDC"}],"standard_charges":[{"gross_charge":712.9,"discounted_cash":712.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"GLYCOPYRROLATE 1 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70700016725","type":"NDC"}],"standard_charges":[{"gross_charge":36.96,"discounted_cash":36.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00641234141","type":"NDC"}],"standard_charges":[{"gross_charge":23.59,"discounted_cash":23.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"XYLOCAINE 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048457","type":"NDC"}],"standard_charges":[{"gross_charge":19.21,"discounted_cash":19.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"63323048557","type":"NDC"}],"standard_charges":[{"gross_charge":13.61,"discounted_cash":13.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048526","type":"NDC"}],"standard_charges":[{"gross_charge":17.96,"discounted_cash":17.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054004641","type":"NDC"}],"standard_charges":[{"gross_charge":100.4,"discounted_cash":100.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"XYLOCAINE 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048527","type":"NDC"}],"standard_charges":[{"gross_charge":16.27,"discounted_cash":16.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048627","type":"NDC"}],"standard_charges":[{"gross_charge":20.51,"discounted_cash":20.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1030","type":"HCPCS"},{"code":"00009028003","type":"NDC"}],"standard_charges":[{"gross_charge":45.23,"discounted_cash":45.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEPO-MEDROL 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009028002","type":"NDC"}],"standard_charges":[{"gross_charge":44.12,"discounted_cash":44.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEPO-MEDROL 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"00009030602","type":"NDC"}],"standard_charges":[{"gross_charge":58.71,"discounted_cash":58.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SENSORCAINE 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046557","type":"NDC"}],"standard_charges":[{"gross_charge":31.93,"discounted_cash":31.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SENSORCAINE 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046757","type":"NDC"}],"standard_charges":[{"gross_charge":17.85,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641614525","type":"NDC"}],"standard_charges":[{"gross_charge":20.59,"discounted_cash":20.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BENDEKA 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9034","type":"HCPCS"},{"code":"63459034804","type":"NDC"}],"standard_charges":[{"gross_charge":9636.37,"discounted_cash":9636.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LACTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121087316","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69452038998","type":"NDC"}],"standard_charges":[{"gross_charge":71.12,"discounted_cash":71.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 148 ML"}]},{"description":"LEVETIRACETAM 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"31722057447","type":"NDC"}],"standard_charges":[{"gross_charge":5.07,"discounted_cash":5.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"FERRIC SUBSULFATE (BULK) SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"38779128408","type":"NDC"}],"standard_charges":[{"gross_charge":43.65,"discounted_cash":43.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ADRENALIN 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42023010301","type":"NDC"}],"standard_charges":[{"gross_charge":708.59,"discounted_cash":708.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"XYLOCAINE 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323048657","type":"NDC"}],"standard_charges":[{"gross_charge":15.42,"discounted_cash":15.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208039830","type":"NDC"}],"standard_charges":[{"gross_charge":236.91,"discounted_cash":236.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LEVOFLOXACIN 25 MG/ML PO SOLN BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00527194866","type":"NDC"}],"standard_charges":[{"gross_charge":463.4,"discounted_cash":463.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054356699","type":"NDC"}],"standard_charges":[{"gross_charge":50.82,"discounted_cash":50.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131545","type":"NDC"}],"standard_charges":[{"gross_charge":17.53,"discounted_cash":17.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 45 ML"}]},{"description":"GADOTERATE MEGLUMINE 50 MMOL/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"65219008850","type":"NDC"}],"standard_charges":[{"gross_charge":54.56,"discounted_cash":54.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"DOTAREM 50 MMOL/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9575","type":"HCPCS"},{"code":"67684200104","type":"NDC"}],"standard_charges":[{"gross_charge":0.36,"discounted_cash":0.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LIPIODOL 480 MG/ML IJ OIL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"J3490","type":"HCPCS"},{"code":"67684190102","type":"NDC"}],"standard_charges":[{"gross_charge":5501.23,"discounted_cash":5501.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"TROPICAMIDE-CYCLOPENTOLATE-PE 1-1-2.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71266821105","type":"NDC"}],"standard_charges":[{"gross_charge":298.36,"discounted_cash":298.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TEGRETOL 100 MG/5ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00078050883","type":"NDC"}],"standard_charges":[{"gross_charge":64.65,"discounted_cash":64.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131695","type":"NDC"}],"standard_charges":[{"gross_charge":17.58,"discounted_cash":17.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"CYSTO-CONRAY II 17.2 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00019086250","type":"NDC"}],"standard_charges":[{"gross_charge":30.08,"discounted_cash":30.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 80 ML"}]},{"description":"ISOVUE-370 76 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131645","type":"NDC"}],"standard_charges":[{"gross_charge":20.84,"discounted_cash":20.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VUEWAY 0.5 MMOL/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"A9573","type":"HCPCS"},{"code":"00270701546","type":"NDC"}],"standard_charges":[{"gross_charge":89.69,"discounted_cash":89.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"ISOVUE-300 61 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9967","type":"HCPCS"},{"code":"00270131595","type":"NDC"}],"standard_charges":[{"gross_charge":19.71,"discounted_cash":19.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CYSTOGRAFIN 30 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014957","type":"NDC"}],"standard_charges":[{"gross_charge":22.83,"discounted_cash":22.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"CYSTOGRAFIN 30 % UR SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"255","type":"RC"},{"code":"Q9958","type":"HCPCS"},{"code":"00270014960","type":"NDC"}],"standard_charges":[{"gross_charge":191.62,"discounted_cash":191.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"MARCAINE/EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409175250","type":"NDC"}],"standard_charges":[{"gross_charge":26.66,"discounted_cash":26.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CONSTULOSE 10 GM/15ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"45963043965","type":"NDC"}],"standard_charges":[{"gross_charge":59.51,"discounted_cash":59.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208041105","type":"NDC"}],"standard_charges":[{"gross_charge":46.86,"discounted_cash":46.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROMETHAZINE HCL 6.25 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70752013812","type":"NDC"}],"standard_charges":[{"gross_charge":15.43,"discounted_cash":15.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ACETIC ACID 3 % SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51552005106","type":"NDC"}],"standard_charges":[{"gross_charge":3.32,"discounted_cash":3.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69452039098","type":"NDC"}],"standard_charges":[{"gross_charge":140.69,"discounted_cash":140.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"EYE WASH OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10119000252","type":"NDC"}],"standard_charges":[{"gross_charge":42.21,"discounted_cash":42.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 118 ML"}]},{"description":"METHADONE HCL 10 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054039168","type":"NDC"}],"standard_charges":[{"gross_charge":3.94,"discounted_cash":3.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054004544","type":"NDC"}],"standard_charges":[{"gross_charge":117.39,"discounted_cash":117.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LACOSAMIDE 10 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72603030501","type":"NDC"}],"standard_charges":[{"gross_charge":19.08,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROMETHAZINE HCL 6.25 MG/5ML PO SYRP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"27808005102","type":"NDC"}],"standard_charges":[{"gross_charge":9.1,"discounted_cash":9.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054051744","type":"NDC"}],"standard_charges":[{"gross_charge":7.68,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"GABAPENTIN 250 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42192060816","type":"NDC"}],"standard_charges":[{"gross_charge":15.53,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"METHADOSE 10 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00406052710","type":"NDC"}],"standard_charges":[{"gross_charge":3.73,"discounted_cash":3.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.9 ML"}]},{"description":"CITALOPRAM HYDROBROMIDE 10 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054006258","type":"NDC"}],"standard_charges":[{"gross_charge":10.94,"discounted_cash":10.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LORAZEPAM 2 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121077001","type":"NDC"}],"standard_charges":[{"gross_charge":7.72,"discounted_cash":7.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SALINE BACTERIOSTATIC 0.9 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J7030","type":"HCPCS"},{"code":"63323092410","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317701","type":"NDC"}],"standard_charges":[{"gross_charge":17.5,"discounted_cash":17.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BUPIVACAINE-EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409904301","type":"NDC"}],"standard_charges":[{"gross_charge":46.34,"discounted_cash":46.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SENSORCAINE/EPINEPHRINE 0.25% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046157","type":"NDC"}],"standard_charges":[{"gross_charge":55.86,"discounted_cash":55.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001326","type":"NDC"}],"standard_charges":[{"gross_charge":40.91,"discounted_cash":40.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010425","type":"NDC"}],"standard_charges":[{"gross_charge":201.08,"discounted_cash":201.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.5 ML"}]},{"description":"FOLIC ACID 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1808","type":"HCPCS"},{"code":"39822110001","type":"NDC"}],"standard_charges":[{"gross_charge":20.51,"discounted_cash":20.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"63323001302","type":"NDC"}],"standard_charges":[{"gross_charge":41.85,"discounted_cash":41.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"69680011225","type":"NDC"}],"standard_charges":[{"gross_charge":41.22,"discounted_cash":41.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"16729011408","type":"NDC"}],"standard_charges":[{"gross_charge":239.3,"discounted_cash":239.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323004710","type":"NDC"}],"standard_charges":[{"gross_charge":29.36,"discounted_cash":29.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641618810","type":"NDC"}],"standard_charges":[{"gross_charge":42.12,"discounted_cash":42.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"00641618910","type":"NDC"}],"standard_charges":[{"gross_charge":55.3,"discounted_cash":55.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001095","type":"NDC"}],"standard_charges":[{"gross_charge":57.72,"discounted_cash":57.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.5 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"72266020410","type":"NDC"}],"standard_charges":[{"gross_charge":44.83,"discounted_cash":44.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"00641622825","type":"NDC"}],"standard_charges":[{"gross_charge":44.69,"discounted_cash":44.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"00713035125","type":"NDC"}],"standard_charges":[{"gross_charge":42.27,"discounted_cash":42.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"70069080210","type":"NDC"}],"standard_charges":[{"gross_charge":58.49,"discounted_cash":58.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ETOPOSIDE 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"00143951101","type":"NDC"}],"standard_charges":[{"gross_charge":53.65,"discounted_cash":53.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"68001051627","type":"NDC"}],"standard_charges":[{"gross_charge":372.04,"discounted_cash":372.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 23 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"00641036725","type":"NDC"}],"standard_charges":[{"gross_charge":17.85,"discounted_cash":17.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70069000510","type":"NDC"}],"standard_charges":[{"gross_charge":33.09,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"25021050002","type":"NDC"}],"standard_charges":[{"gross_charge":44.37,"discounted_cash":44.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MESNA 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9209","type":"HCPCS"},{"code":"10019095301","type":"NDC"}],"standard_charges":[{"gross_charge":64.22,"discounted_cash":64.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"43066009025","type":"NDC"}],"standard_charges":[{"gross_charge":33.53,"discounted_cash":33.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"THIAMINE HCL 100 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3411","type":"HCPCS"},{"code":"67457019602","type":"NDC"}],"standard_charges":[{"gross_charge":39.18,"discounted_cash":39.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"00517003125","type":"NDC"}],"standard_charges":[{"gross_charge":37.65,"discounted_cash":37.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150038601","type":"NDC"}],"standard_charges":[{"gross_charge":88.12,"discounted_cash":88.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.2 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641606125","type":"NDC"}],"standard_charges":[{"gross_charge":14.91,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"00069154220","type":"NDC"}],"standard_charges":[{"gross_charge":186.58,"discounted_cash":186.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16.5 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"67457012410","type":"NDC"}],"standard_charges":[{"gross_charge":15.37,"discounted_cash":15.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DOXORUBICIN HCL 2 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9000","type":"HCPCS"},{"code":"45963073360","type":"NDC"}],"standard_charges":[{"gross_charge":122.37,"discounted_cash":122.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"ENOXAPARIN SODIUM 300 MG/3ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560800","type":"NDC"}],"standard_charges":[{"gross_charge":60.16,"discounted_cash":60.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"71288030302","type":"NDC"}],"standard_charges":[{"gross_charge":34.17,"discounted_cash":34.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYCLOSPORINE MODIFIED 100 MG/ML PO SOLN UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7502","type":"HCPCS"},{"code":"00172731320","type":"NDC"}],"standard_charges":[{"gross_charge":29.55,"discounted_cash":29.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"62332077931","type":"NDC"}],"standard_charges":[{"gross_charge":971.82,"discounted_cash":971.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 70 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048327","type":"NDC"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":17.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SENSORCAINE/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046357","type":"NDC"}],"standard_charges":[{"gross_charge":111.21,"discounted_cash":111.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MARCAINE/EPINEPHRINE 0.5% -1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409175550","type":"NDC"}],"standard_charges":[{"gross_charge":43.48,"discounted_cash":43.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 0.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048157","type":"NDC"}],"standard_charges":[{"gross_charge":38.9,"discounted_cash":38.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TUBERSOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"49281075221","type":"NDC"}],"standard_charges":[{"gross_charge":64.75,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"APLISOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"42023010401","type":"NDC"}],"standard_charges":[{"gross_charge":77.54,"discounted_cash":77.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"TUBERSOL 5 UNIT/0.1ML ID SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"250","type":"RC"},{"code":"86580","type":"HCPCS"},{"code":"49281075222","type":"NDC"}],"standard_charges":[{"gross_charge":69.03,"discounted_cash":69.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033956","type":"NDC"}],"standard_charges":[{"gross_charge":31.8,"discounted_cash":31.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"25021025550","type":"NDC"}],"standard_charges":[{"gross_charge":159.4,"discounted_cash":159.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10.5 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"71288080876","type":"NDC"}],"standard_charges":[{"gross_charge":51.58,"discounted_cash":51.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"16729029512","type":"NDC"}],"standard_charges":[{"gross_charge":31.72,"discounted_cash":31.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"55150033501","type":"NDC"}],"standard_charges":[{"gross_charge":341.05,"discounted_cash":341.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 29 ML"}]},{"description":"PACLITAXEL 300 MG/50ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9267","type":"HCPCS"},{"code":"16714013701","type":"NDC"}],"standard_charges":[{"gross_charge":133.26,"discounted_cash":133.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641620725","type":"NDC"}],"standard_charges":[{"gross_charge":15.61,"discounted_cash":15.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"PHENYLEPHRINE HCL (PRESSORS) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2371","type":"HCPCS"},{"code":"55150030110","type":"NDC"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":47.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CARBOPLATIN 600 MG/60ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"54288016701","type":"NDC"}],"standard_charges":[{"gross_charge":226.17,"discounted_cash":226.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"70069037125","type":"NDC"}],"standard_charges":[{"gross_charge":24.6,"discounted_cash":24.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TOBRAMYCIN SULFATE 80 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3260","type":"HCPCS"},{"code":"63323030602","type":"NDC"}],"standard_charges":[{"gross_charge":50.4,"discounted_cash":50.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054214","type":"NDC"}],"standard_charges":[{"gross_charge":60.68,"discounted_cash":60.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"67457064002","type":"NDC"}],"standard_charges":[{"gross_charge":46.76,"discounted_cash":46.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"INSULIN LISPRO 100 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1815","type":"HCPCS"},{"code":"00002773701","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.08 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004401","type":"NDC"}],"standard_charges":[{"gross_charge":33.97,"discounted_cash":33.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"76329826101","type":"NDC"}],"standard_charges":[{"gross_charge":15.16,"discounted_cash":15.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"ETOPOSIDE 1 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"00143951201","type":"NDC"}],"standard_charges":[{"gross_charge":156.17,"discounted_cash":156.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.3 ML"}]},{"description":"PROCHLORPERAZINE EDISYLATE 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0780","type":"HCPCS"},{"code":"83634077802","type":"NDC"}],"standard_charges":[{"gross_charge":31.39,"discounted_cash":31.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"70512084025","type":"NDC"}],"standard_charges":[{"gross_charge":31.39,"discounted_cash":31.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"63323004444","type":"NDC"}],"standard_charges":[{"gross_charge":33.97,"discounted_cash":33.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048227","type":"NDC"}],"standard_charges":[{"gross_charge":14.9,"discounted_cash":14.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048257","type":"NDC"}],"standard_charges":[{"gross_charge":16.07,"discounted_cash":16.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"XYLOCAINE/EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048357","type":"NDC"}],"standard_charges":[{"gross_charge":31.03,"discounted_cash":31.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"63323041202","type":"NDC"}],"standard_charges":[{"gross_charge":48.37,"discounted_cash":48.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409000710","type":"NDC"}],"standard_charges":[{"gross_charge":25.73,"discounted_cash":25.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"72266010301","type":"NDC"}],"standard_charges":[{"gross_charge":98.52,"discounted_cash":98.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 120 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323016505","type":"NDC"}],"standard_charges":[{"gross_charge":15.53,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487960101","type":"NDC"}],"standard_charges":[{"gross_charge":50.78,"discounted_cash":50.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069005101","type":"NDC"}],"standard_charges":[{"gross_charge":103.11,"discounted_cash":103.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069001701","type":"NDC"}],"standard_charges":[{"gross_charge":50.98,"discounted_cash":50.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063305","type":"NDC"}],"standard_charges":[{"gross_charge":49.57,"discounted_cash":49.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CEFPODOXIME PROXETIL 100 MG/5ML PO SUSR BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980040350","type":"NDC"}],"standard_charges":[{"gross_charge":96.65,"discounted_cash":96.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093818064","type":"NDC"}],"standard_charges":[{"gross_charge":48.92,"discounted_cash":48.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314012605","type":"NDC"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOTIFEN FUMARATE 0.035 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72485061710","type":"NDC"}],"standard_charges":[{"gross_charge":79.3,"discounted_cash":79.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42571013725","type":"NDC"}],"standard_charges":[{"gross_charge":76.59,"discounted_cash":76.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208073006","type":"NDC"}],"standard_charges":[{"gross_charge":174.04,"discounted_cash":174.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505056000","type":"NDC"}],"standard_charges":[{"gross_charge":96.93,"discounted_cash":96.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65862094601","type":"NDC"}],"standard_charges":[{"gross_charge":130.84,"discounted_cash":130.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69238161503","type":"NDC"}],"standard_charges":[{"gross_charge":98.54,"discounted_cash":98.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687052483","type":"NDC"}],"standard_charges":[{"gross_charge":45.17,"discounted_cash":45.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030805","type":"NDC"}],"standard_charges":[{"gross_charge":92.44,"discounted_cash":92.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72266015801","type":"NDC"}],"standard_charges":[{"gross_charge":114.96,"discounted_cash":114.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051505","type":"NDC"}],"standard_charges":[{"gross_charge":98.96,"discounted_cash":98.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314012610","type":"NDC"}],"standard_charges":[{"gross_charge":79.24,"discounted_cash":79.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505100301","type":"NDC"}],"standard_charges":[{"gross_charge":68.49,"discounted_cash":68.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HALOPERIDOL LACTATE 2 MG/ML PO CONC UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121058115","type":"NDC"}],"standard_charges":[{"gross_charge":17.37,"discounted_cash":17.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069042103","type":"NDC"}],"standard_charges":[{"gross_charge":46.86,"discounted_cash":46.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42571013726","type":"NDC"}],"standard_charges":[{"gross_charge":85.06,"discounted_cash":85.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00781713593","type":"NDC"}],"standard_charges":[{"gross_charge":73.49,"discounted_cash":73.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"OLOPATADINE HCL 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70512052005","type":"NDC"}],"standard_charges":[{"gross_charge":92.04,"discounted_cash":92.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BETADINE OPHTHALMIC PREP 5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065041130","type":"NDC"}],"standard_charges":[{"gross_charge":73.69,"discounted_cash":73.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"EYE ITCH RELIEF 0.035 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00536125240","type":"NDC"}],"standard_charges":[{"gross_charge":75.18,"discounted_cash":75.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALAWAY 0.035 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208060110","type":"NDC"}],"standard_charges":[{"gross_charge":113.4,"discounted_cash":113.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ALPHAGAN P 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00023932105","type":"NDC"}],"standard_charges":[{"gross_charge":860.77,"discounted_cash":860.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BUDESONIDE 1 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69097032153","type":"NDC"}],"standard_charges":[{"gross_charge":51.24,"discounted_cash":51.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208073506","type":"NDC"}],"standard_charges":[{"gross_charge":184.36,"discounted_cash":184.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208046325","type":"NDC"}],"standard_charges":[{"gross_charge":40.94,"discounted_cash":40.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714052601","type":"NDC"}],"standard_charges":[{"gross_charge":257.12,"discounted_cash":257.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"FLUOROMETHOLONE 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758088005","type":"NDC"}],"standard_charges":[{"gross_charge":333.19,"discounted_cash":333.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TRIFLURIDINE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314004475","type":"NDC"}],"standard_charges":[{"gross_charge":868.1,"discounted_cash":868.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71921022610","type":"NDC"}],"standard_charges":[{"gross_charge":145.16,"discounted_cash":145.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69315030802","type":"NDC"}],"standard_charges":[{"gross_charge":126.4,"discounted_cash":126.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"PHENYLEPHRINE HCL 2.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756062925","type":"NDC"}],"standard_charges":[{"gross_charge":204.97,"discounted_cash":204.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208043405","type":"NDC"}],"standard_charges":[{"gross_charge":133.22,"discounted_cash":133.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505056401","type":"NDC"}],"standard_charges":[{"gross_charge":275.23,"discounted_cash":275.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714062801","type":"NDC"}],"standard_charges":[{"gross_charge":505.81,"discounted_cash":505.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"TROPICAMIDE-CYCLOPENTOLATE-PE 1-1-2.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71449009245","type":"NDC"}],"standard_charges":[{"gross_charge":248.42,"discounted_cash":248.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GATIFLOXACIN 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314067225","type":"NDC"}],"standard_charges":[{"gross_charge":290.33,"discounted_cash":290.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"82182032105","type":"NDC"}],"standard_charges":[{"gross_charge":469.3,"discounted_cash":469.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505058204","type":"NDC"}],"standard_charges":[{"gross_charge":297.88,"discounted_cash":297.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CALCITONIN (SALMON) 200 UNIT/ACT NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082306","type":"NDC"}],"standard_charges":[{"gross_charge":265.33,"discounted_cash":265.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.7 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.15 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014405","type":"NDC"}],"standard_charges":[{"gross_charge":345.94,"discounted_cash":345.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208072002","type":"NDC"}],"standard_charges":[{"gross_charge":284.85,"discounted_cash":284.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63323069444","type":"NDC"}],"standard_charges":[{"gross_charge":39.71,"discounted_cash":39.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314054701","type":"NDC"}],"standard_charges":[{"gross_charge":47.89,"discounted_cash":47.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69097031953","type":"NDC"}],"standard_charges":[{"gross_charge":74.48,"discounted_cash":74.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314001910","type":"NDC"}],"standard_charges":[{"gross_charge":94.68,"discounted_cash":94.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROPARACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314001601","type":"NDC"}],"standard_charges":[{"gross_charge":174.89,"discounted_cash":174.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TIMOLOL MALEATE 0.25 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051305","type":"NDC"}],"standard_charges":[{"gross_charge":35.41,"discounted_cash":35.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051415","type":"NDC"}],"standard_charges":[{"gross_charge":104.02,"discounted_cash":104.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"OFLOXACIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756060730","type":"NDC"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487970101","type":"NDC"}],"standard_charges":[{"gross_charge":42.64,"discounted_cash":42.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62332050503","type":"NDC"}],"standard_charges":[{"gross_charge":120.36,"discounted_cash":120.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180042201","type":"NDC"}],"standard_charges":[{"gross_charge":113.53,"discounted_cash":113.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"TOBRAMYCIN 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069013101","type":"NDC"}],"standard_charges":[{"gross_charge":61.02,"discounted_cash":61.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208048510","type":"NDC"}],"standard_charges":[{"gross_charge":113.66,"discounted_cash":113.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301105","type":"NDC"}],"standard_charges":[{"gross_charge":66.43,"discounted_cash":66.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314064610","type":"NDC"}],"standard_charges":[{"gross_charge":276.36,"discounted_cash":276.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62135071242","type":"NDC"}],"standard_charges":[{"gross_charge":41.07,"discounted_cash":41.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208048610","type":"NDC"}],"standard_charges":[{"gross_charge":104.78,"discounted_cash":104.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314065605","type":"NDC"}],"standard_charges":[{"gross_charge":48.15,"discounted_cash":48.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014310","type":"NDC"}],"standard_charges":[{"gross_charge":50.73,"discounted_cash":50.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LEVALBUTEROL HCL 0.63 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7612","type":"HCPCS"},{"code":"76204080001","type":"NDC"}],"standard_charges":[{"gross_charge":21.27,"discounted_cash":21.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIDOCAINE HCL URETHRAL/MUCOSAL 2 % EX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76329301305","type":"NDC"}],"standard_charges":[{"gross_charge":81.36,"discounted_cash":81.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BSS PLUS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065080050","type":"NDC"}],"standard_charges":[{"gross_charge":36.54,"discounted_cash":36.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CALAMINE 8-8 % EX LOTN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904253321","type":"NDC"}],"standard_charges":[{"gross_charge":23.88,"discounted_cash":23.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 177 ML"}]},{"description":"AMOXICILLIN 250 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00143988980","type":"NDC"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":12.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ACTIDOSE WITH SORBITOL 25 GM/120ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574052074","type":"NDC"}],"standard_charges":[{"gross_charge":220.68,"discounted_cash":220.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"BSS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065179504","type":"NDC"}],"standard_charges":[{"gross_charge":79.94,"discounted_cash":79.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020025","type":"NDC"}],"standard_charges":[{"gross_charge":5.76,"discounted_cash":5.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60687039583","type":"NDC"}],"standard_charges":[{"gross_charge":4.8,"discounted_cash":4.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"BSS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065079550","type":"NDC"}],"standard_charges":[{"gross_charge":9.55,"discounted_cash":9.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"DIPHENOXYLATE-ATROPINE 2.5-0.025 MG/5ML PO LIQD UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054319446","type":"NDC"}],"standard_charges":[{"gross_charge":48.78,"discounted_cash":48.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"63323069404","type":"NDC"}],"standard_charges":[{"gross_charge":35.04,"discounted_cash":35.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LATANOPROST 0.005 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59762033302","type":"NDC"}],"standard_charges":[{"gross_charge":32.06,"discounted_cash":32.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314003002","type":"NDC"}],"standard_charges":[{"gross_charge":131.26,"discounted_cash":131.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714052701","type":"NDC"}],"standard_charges":[{"gross_charge":247.02,"discounted_cash":247.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063006","type":"NDC"}],"standard_charges":[{"gross_charge":99.81,"discounted_cash":99.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DORZOLAMIDE HCL-TIMOLOL MAL 2-0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42571014726","type":"NDC"}],"standard_charges":[{"gross_charge":227.43,"discounted_cash":227.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70748033202","type":"NDC"}],"standard_charges":[{"gross_charge":173.94,"discounted_cash":173.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE SULFATE (CONCENTRATE) 100 MG/5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00406800330","type":"NDC"}],"standard_charges":[{"gross_charge":10.46,"discounted_cash":10.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"MAXITROL 0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"82667010005","type":"NDC"}],"standard_charges":[{"gross_charge":502.43,"discounted_cash":502.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PEG-3350/ELECTROLYTES 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64380076621","type":"NDC"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":182.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"PEG-3350/ELECTROLYTES 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"10572010001","type":"NDC"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":182.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"GOLYTELY 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"52268010001","type":"NDC"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":182.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"GAVILYTE-G 236 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43386009019","type":"NDC"}],"standard_charges":[{"gross_charge":182.35,"discounted_cash":182.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"MURO 128 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208027615","type":"NDC"}],"standard_charges":[{"gross_charge":104.76,"discounted_cash":104.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LOPERAMIDE HCL 1 MG/7.5ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904683620","type":"NDC"}],"standard_charges":[{"gross_charge":13.86,"discounted_cash":13.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GNP INFANT GAS RELIEF 20 MG/0.3ML PO SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122054703","type":"NDC"}],"standard_charges":[{"gross_charge":4.16,"discounted_cash":4.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"NEBUSAL 3 % IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50190014263","type":"NDC"}],"standard_charges":[{"gross_charge":11.72,"discounted_cash":11.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"POLYMYXIN B-TRIMETHOPRIM 10000-0.1 UNIT/ML-% OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314062810","type":"NDC"}],"standard_charges":[{"gross_charge":53.04,"discounted_cash":53.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CIPROFLOXACIN-DEXAMETHASONE 0.3-0.1 % OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"62756042790","type":"NDC"}],"standard_charges":[{"gross_charge":809.09,"discounted_cash":809.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"GENTEAL TEARS 0.1-0.2-0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065042636","type":"NDC"}],"standard_charges":[{"gross_charge":80.52,"discounted_cash":80.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"AZELASTINE HCL 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42291009430","type":"NDC"}],"standard_charges":[{"gross_charge":74.96,"discounted_cash":74.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64980051405","type":"NDC"}],"standard_charges":[{"gross_charge":65.65,"discounted_cash":65.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314022705","type":"NDC"}],"standard_charges":[{"gross_charge":61.28,"discounted_cash":61.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CIPROFLOXACIN HCL 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314065625","type":"NDC"}],"standard_charges":[{"gross_charge":55.74,"discounted_cash":55.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208058564","type":"NDC"}],"standard_charges":[{"gross_charge":194.68,"discounted_cash":194.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ACETYLCYSTEINE 20 % IN SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00517760425","type":"NDC"}],"standard_charges":[{"gross_charge":87.43,"discounted_cash":87.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PILOCARPINE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314020315","type":"NDC"}],"standard_charges":[{"gross_charge":292.66,"discounted_cash":292.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574403125","type":"NDC"}],"standard_charges":[{"gross_charge":122.28,"discounted_cash":122.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314001405","type":"NDC"}],"standard_charges":[{"gross_charge":70.03,"discounted_cash":70.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TIMOLOL MALEATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758080105","type":"NDC"}],"standard_charges":[{"gross_charge":67.07,"discounted_cash":67.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378827055","type":"NDC"}],"standard_charges":[{"gross_charge":7.56,"discounted_cash":7.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"OSELTAMIVIR PHOSPHATE 6 MG/ML PO SUSR BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"27241013909","type":"NDC"}],"standard_charges":[{"gross_charge":21.39,"discounted_cash":21.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12.5 ML"}]},{"description":"CEPHALEXIN 250 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093417773","type":"NDC"}],"standard_charges":[{"gross_charge":16.59,"discounted_cash":16.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BSS PLUS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065080094","type":"NDC"}],"standard_charges":[{"gross_charge":5.45,"discounted_cash":5.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MINERAL OIL RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"53329001311","type":"NDC"}],"standard_charges":[{"gross_charge":36.95,"discounted_cash":36.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"POVIDONE-IODINE 10 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904110309","type":"NDC"}],"standard_charges":[{"gross_charge":4.58,"discounted_cash":4.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"45802041059","type":"NDC"}],"standard_charges":[{"gross_charge":20.14,"discounted_cash":20.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00378827052","type":"NDC"}],"standard_charges":[{"gross_charge":6.45,"discounted_cash":6.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"LIDOCAINE VISCOUS HCL 2 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72888012526","type":"NDC"}],"standard_charges":[{"gross_charge":8.65,"discounted_cash":8.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"FLEET PEDIATRIC RECTAL ENEMA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00132020220","type":"NDC"}],"standard_charges":[{"gross_charge":23.01,"discounted_cash":23.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 66 ML"}]},{"description":"ALBUTEROL SULFATE (2.5 MG/3ML) 0.083% IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76204020030","type":"NDC"}],"standard_charges":[{"gross_charge":6.38,"discounted_cash":6.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180072305","type":"NDC"}],"standard_charges":[{"gross_charge":20.43,"discounted_cash":20.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65862021901","type":"NDC"}],"standard_charges":[{"gross_charge":20.43,"discounted_cash":20.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180098430","type":"NDC"}],"standard_charges":[{"gross_charge":33.94,"discounted_cash":33.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314014305","type":"NDC"}],"standard_charges":[{"gross_charge":40.69,"discounted_cash":40.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60432046551","type":"NDC"}],"standard_charges":[{"gross_charge":208.06,"discounted_cash":208.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.03 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082601","type":"NDC"}],"standard_charges":[{"gross_charge":108.13,"discounted_cash":108.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"LIDOCAINE HCL 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70954051810","type":"NDC"}],"standard_charges":[{"gross_charge":101.56,"discounted_cash":101.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"OXYMETAZOLINE HCL 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"11523116705","type":"NDC"}],"standard_charges":[{"gross_charge":111.6,"discounted_cash":111.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"BSS IO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065079515","type":"NDC"}],"standard_charges":[{"gross_charge":17.36,"discounted_cash":17.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.25 ML"}]},{"description":"CEFDINIR 125 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65862021860","type":"NDC"}],"standard_charges":[{"gross_charge":51.89,"discounted_cash":51.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00832141003","type":"NDC"}],"standard_charges":[{"gross_charge":169.03,"discounted_cash":169.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758011905","type":"NDC"}],"standard_charges":[{"gross_charge":164.18,"discounted_cash":164.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"EPINEPHRINE HCL (NASAL) 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"54288012301","type":"NDC"}],"standard_charges":[{"gross_charge":245.57,"discounted_cash":245.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ARTIFICIAL TEARS 0.2-0.2-1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"57896018105","type":"NDC"}],"standard_charges":[{"gross_charge":26.55,"discounted_cash":26.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"H-CHLOR 12 0.125 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328006412","type":"NDC"}],"standard_charges":[{"gross_charge":75.77,"discounted_cash":75.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"HYSEPT 25 0.25 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328006325","type":"NDC"}],"standard_charges":[{"gross_charge":31.03,"discounted_cash":31.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"GAVILYTE-C 240 G PO SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"43386006019","type":"NDC"}],"standard_charges":[{"gross_charge":146.19,"discounted_cash":146.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4000 ML"}]},{"description":"GNP MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122074038","type":"NDC"}],"standard_charges":[{"gross_charge":140.69,"discounted_cash":140.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"ONELAX MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71399788901","type":"NDC"}],"standard_charges":[{"gross_charge":12.65,"discounted_cash":12.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"ONELAX MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71399005101","type":"NDC"}],"standard_charges":[{"gross_charge":34.23,"discounted_cash":34.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"FLEET OIL RE ENEM","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00132030140","type":"NDC"}],"standard_charges":[{"gross_charge":32.25,"discounted_cash":32.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 133 ML"}]},{"description":"AKTEN 3.5 % OP GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"82584079225","type":"NDC"}],"standard_charges":[{"gross_charge":152.61,"discounted_cash":152.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60219174903","type":"NDC"}],"standard_charges":[{"gross_charge":283.17,"discounted_cash":283.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 0.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758077305","type":"NDC"}],"standard_charges":[{"gross_charge":265.33,"discounted_cash":265.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"12 HOUR DECONGESTANT 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69618005051","type":"NDC"}],"standard_charges":[{"gross_charge":35.51,"discounted_cash":35.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"GNP NO DRIP NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24385035210","type":"NDC"}],"standard_charges":[{"gross_charge":35.0,"discounted_cash":35.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"NASAL DECONGESTANT SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904742730","type":"NDC"}],"standard_charges":[{"gross_charge":33.46,"discounted_cash":33.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"FT NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70677103701","type":"NDC"}],"standard_charges":[{"gross_charge":31.93,"discounted_cash":31.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"VICKS SINEX MOISTURIZING 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"23900002326","type":"NDC"}],"standard_charges":[{"gross_charge":88.82,"discounted_cash":88.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"VICKS SINEX 12 HOUR DECONGEST 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"37000080301","type":"NDC"}],"standard_charges":[{"gross_charge":53.88,"discounted_cash":53.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"AFRIN NODRIP EXTRA MOISTURE 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"41100001511","type":"NDC"}],"standard_charges":[{"gross_charge":93.26,"discounted_cash":93.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GNP NASAL SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122016510","type":"NDC"}],"standard_charges":[{"gross_charge":19.12,"discounted_cash":19.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"NASAL DECONGESTANT SPRAY 0.05 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904743535","type":"NDC"}],"standard_charges":[{"gross_charge":28.08,"discounted_cash":28.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRG MILD 0.25 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225080047","type":"NDC"}],"standard_charges":[{"gross_charge":43.65,"discounted_cash":43.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRGY REG 0.5 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225080547","type":"NDC"}],"standard_charges":[{"gross_charge":43.65,"discounted_cash":43.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NEO-SYNEPHRINE COLD/ALLRGY EXT 1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00225081047","type":"NDC"}],"standard_charges":[{"gross_charge":48.47,"discounted_cash":48.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904698516","type":"NDC"}],"standard_charges":[{"gross_charge":2.49,"discounted_cash":2.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904698520","type":"NDC"}],"standard_charges":[{"gross_charge":3.62,"discounted_cash":3.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.333 ML"}]},{"description":"EAR DROPS 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904662735","type":"NDC"}],"standard_charges":[{"gross_charge":26.03,"discounted_cash":26.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GNP EARWAX REMOVAL DROPS 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122055705","type":"NDC"}],"standard_charges":[{"gross_charge":17.84,"discounted_cash":17.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MURINE EAR 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"78112073623","type":"NDC"}],"standard_charges":[{"gross_charge":47.12,"discounted_cash":47.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"GEBAUERS PAIN EASE EX AERO","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00386000803","type":"NDC"}],"standard_charges":[{"gross_charge":203.04,"discounted_cash":203.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 116 ML"}]},{"description":"IODINE STRONG 5 % PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"999","type":"RC"},{"code":"48433023015","type":"NDC"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":17.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DICLOFENAC SODIUM 0.1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208045705","type":"NDC"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":14.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GNP ALL DAY ALLERGY CHILDRENS 1 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122020326","type":"NDC"}],"standard_charges":[{"gross_charge":3.9,"discounted_cash":3.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"DAKINS (1/2 STRENGTH) 0.25 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00436093616","type":"NDC"}],"standard_charges":[{"gross_charge":92.37,"discounted_cash":92.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272002","type":"NDC"}],"standard_charges":[{"gross_charge":15.27,"discounted_cash":15.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030110","type":"NDC"}],"standard_charges":[{"gross_charge":41.73,"discounted_cash":41.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CARBOPLATIN 450 MG/45ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9045","type":"HCPCS"},{"code":"61703033950","type":"NDC"}],"standard_charges":[{"gross_charge":128.69,"discounted_cash":128.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"16729027638","type":"NDC"}],"standard_charges":[{"gross_charge":204.57,"discounted_cash":204.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"00641614910","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ONDANSETRON HCL 40 MG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054931","type":"NDC"}],"standard_charges":[{"gross_charge":20.46,"discounted_cash":20.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042096","type":"NDC"}],"standard_charges":[{"gross_charge":12.73,"discounted_cash":12.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BUPIVACAINE HCL 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150024950","type":"NDC"}],"standard_charges":[{"gross_charge":13.17,"discounted_cash":13.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427601","type":"NDC"}],"standard_charges":[{"gross_charge":12.67,"discounted_cash":12.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE 2 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409014710","type":"NDC"}],"standard_charges":[{"gross_charge":27.58,"discounted_cash":27.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"MIDAZOLAM HCL 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00641621010","type":"NDC"}],"standard_charges":[{"gross_charge":14.61,"discounted_cash":14.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"63323041510","type":"NDC"}],"standard_charges":[{"gross_charge":17.15,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"25021061110","type":"NDC"}],"standard_charges":[{"gross_charge":17.89,"discounted_cash":17.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054015","type":"NDC"}],"standard_charges":[{"gross_charge":37.77,"discounted_cash":37.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"GENTAMICIN SULFATE 40 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323001002","type":"NDC"}],"standard_charges":[{"gross_charge":14.86,"discounted_cash":14.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"AMIODARONE HCL 450 MG/9ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"67457015309","type":"NDC"}],"standard_charges":[{"gross_charge":58.87,"discounted_cash":58.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9 ML"}]},{"description":"ETOPOSIDE 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9181","type":"HCPCS"},{"code":"63323010406","type":"NDC"}],"standard_charges":[{"gross_charge":131.69,"discounted_cash":131.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604610","type":"NDC"}],"standard_charges":[{"gross_charge":17.47,"discounted_cash":17.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"00143950501","type":"NDC"}],"standard_charges":[{"gross_charge":36.36,"discounted_cash":36.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 20 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"25021005205","type":"NDC"}],"standard_charges":[{"gross_charge":20.04,"discounted_cash":20.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040010","type":"NDC"}],"standard_charges":[{"gross_charge":16.1,"discounted_cash":16.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00781354025","type":"NDC"}],"standard_charges":[{"gross_charge":20.72,"discounted_cash":20.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.7 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 100 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"63323051610","type":"NDC"}],"standard_charges":[{"gross_charge":16.24,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"CISPLATIN 100 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9060","type":"HCPCS"},{"code":"16729028838","type":"NDC"}],"standard_charges":[{"gross_charge":80.31,"discounted_cash":80.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70069030125","type":"NDC"}],"standard_charges":[{"gross_charge":16.79,"discounted_cash":16.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"25021040067","type":"NDC"}],"standard_charges":[{"gross_charge":18.45,"discounted_cash":18.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.8 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"71288015476","type":"NDC"}],"standard_charges":[{"gross_charge":69.26,"discounted_cash":69.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 13 ML"}]},{"description":"ONDANSETRON HCL 40 MG/20ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00641607901","type":"NDC"}],"standard_charges":[{"gross_charge":17.64,"discounted_cash":17.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ANTI-ITCH 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"51672208902","type":"NDC"}],"standard_charges":[{"gross_charge":31.96,"discounted_cash":31.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28.4 GR"}]},{"description":"HYSEPT 50 0.5 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"39328006250","type":"NDC"}],"standard_charges":[{"gross_charge":130.56,"discounted_cash":130.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 473 ML"}]},{"description":"VISINE RED EYE COMFORT 0.05 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69968035501","type":"NDC"}],"standard_charges":[{"gross_charge":52.33,"discounted_cash":52.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069019101","type":"NDC"}],"standard_charges":[{"gross_charge":229.54,"discounted_cash":229.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314039601","type":"NDC"}],"standard_charges":[{"gross_charge":55.1,"discounted_cash":55.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE HCL 4 % MT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"76329630005","type":"NDC"}],"standard_charges":[{"gross_charge":185.21,"discounted_cash":185.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208073501","type":"NDC"}],"standard_charges":[{"gross_charge":80.22,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROVOCHOLINE IN KIT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"64281011006","type":"NDC"}],"standard_charges":[{"gross_charge":611.82,"discounted_cash":611.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208058060","type":"NDC"}],"standard_charges":[{"gross_charge":231.92,"discounted_cash":231.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505622600","type":"NDC"}],"standard_charges":[{"gross_charge":126.48,"discounted_cash":126.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CEFDINIR 125 MG/5ML PO SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877054798","type":"NDC"}],"standard_charges":[{"gross_charge":26.72,"discounted_cash":26.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069012101","type":"NDC"}],"standard_charges":[{"gross_charge":75.5,"discounted_cash":75.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"76204090025","type":"NDC"}],"standard_charges":[{"gross_charge":12.28,"discounted_cash":12.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069023201","type":"NDC"}],"standard_charges":[{"gross_charge":40.56,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CARBAMIDE PEROXIDE 6.5 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00074736201","type":"NDC"}],"standard_charges":[{"gross_charge":53.88,"discounted_cash":53.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CYCLOPENTOLATE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314039603","type":"NDC"}],"standard_charges":[{"gross_charge":110.25,"discounted_cash":110.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"MAGIC MOUTHWASH SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65628005004","type":"NDC"}],"standard_charges":[{"gross_charge":75.48,"discounted_cash":75.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"CEFDINIR 250 MG/5ML PO SUSR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68180072304","type":"NDC"}],"standard_charges":[{"gross_charge":26.72,"discounted_cash":26.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"DIPHENHYDRAMINE HCL 12.5 MG/5ML PO ELIX","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00121097800","type":"NDC"}],"standard_charges":[{"gross_charge":51.78,"discounted_cash":51.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MAGIC MOUTHWASH SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65628005001","type":"NDC"}],"standard_charges":[{"gross_charge":64.75,"discounted_cash":64.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL 4 % EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00527600480","type":"NDC"}],"standard_charges":[{"gross_charge":119.84,"discounted_cash":119.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"OXCARBAZEPINE 300 MG/5ML PO SUSP UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"65162064978","type":"NDC"}],"standard_charges":[{"gross_charge":15.24,"discounted_cash":15.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314035502","type":"NDC"}],"standard_charges":[{"gross_charge":61.02,"discounted_cash":61.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ARTIFICIAL TEARS OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268004315","type":"NDC"}],"standard_charges":[{"gross_charge":76.08,"discounted_cash":76.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LEVALBUTEROL HCL 1.25 MG/3ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"J7620","type":"HCPCS"},{"code":"00093414856","type":"NDC"}],"standard_charges":[{"gross_charge":26.5,"discounted_cash":26.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"EYE STREAM OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065053001","type":"NDC"}],"standard_charges":[{"gross_charge":130.55,"discounted_cash":130.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"AZELASTINE HCL 0.1 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505083305","type":"NDC"}],"standard_charges":[{"gross_charge":75.69,"discounted_cash":75.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"POLYVINYL ALCOHOL 1.4 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"50268067815","type":"NDC"}],"standard_charges":[{"gross_charge":96.74,"discounted_cash":96.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"IPRATROPIUM BROMIDE 0.06 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505082701","type":"NDC"}],"standard_charges":[{"gross_charge":108.13,"discounted_cash":108.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"BRIMONIDINE TARTRATE 0.2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069023101","type":"NDC"}],"standard_charges":[{"gross_charge":37.47,"discounted_cash":37.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"CEFPODOXIME PROXETIL 100 MG/5ML PO SUSR BULK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714040302","type":"NDC"}],"standard_charges":[{"gross_charge":66.64,"discounted_cash":66.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208041005","type":"NDC"}],"standard_charges":[{"gross_charge":322.97,"discounted_cash":322.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PREDNISOLONE ACETATE 1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314063705","type":"NDC"}],"standard_charges":[{"gross_charge":157.51,"discounted_cash":157.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-HC 3.5-10000-1 OT SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208063562","type":"NDC"}],"standard_charges":[{"gross_charge":234.59,"discounted_cash":234.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"68682092005","type":"NDC"}],"standard_charges":[{"gross_charge":176.54,"discounted_cash":176.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PILOCARPINE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314020415","type":"NDC"}],"standard_charges":[{"gross_charge":226.48,"discounted_cash":226.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PILOCARPINE HCL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069018101","type":"NDC"}],"standard_charges":[{"gross_charge":257.23,"discounted_cash":257.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"TIMOLOL HEMIHYDRATE 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70069069601","type":"NDC"}],"standard_charges":[{"gross_charge":488.42,"discounted_cash":488.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TROPICAMIDE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"61314035501","type":"NDC"}],"standard_charges":[{"gross_charge":95.27,"discounted_cash":95.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"OFLOXACIN 0.3 % OT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756060915","type":"NDC"}],"standard_charges":[{"gross_charge":79.73,"discounted_cash":79.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DORZOLAMIDE HCL 2 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"42571014126","type":"NDC"}],"standard_charges":[{"gross_charge":220.41,"discounted_cash":220.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TETRACAINE HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065074114","type":"NDC"}],"standard_charges":[{"gross_charge":87.1,"discounted_cash":87.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NEOMYCIN-POLYMYXIN-DEXAMETH 3.5-10000-0.1 OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208083060","type":"NDC"}],"standard_charges":[{"gross_charge":93.91,"discounted_cash":93.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VANCOMYCIN HCL 50 MG/ML PO SOLR UNIT DOSE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"67877075181","type":"NDC"}],"standard_charges":[{"gross_charge":32.57,"discounted_cash":32.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"GENTAMICIN SULFATE 0.3 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60758018805","type":"NDC"}],"standard_charges":[{"gross_charge":54.07,"discounted_cash":54.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69097031987","type":"NDC"}],"standard_charges":[{"gross_charge":29.91,"discounted_cash":29.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUDESONIDE 0.5 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093681673","type":"NDC"}],"standard_charges":[{"gross_charge":29.91,"discounted_cash":29.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CYCLOGYL 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00065039605","type":"NDC"}],"standard_charges":[{"gross_charge":268.76,"discounted_cash":268.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYOSYNE 0.125 MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"54838050615","type":"NDC"}],"standard_charges":[{"gross_charge":19.01,"discounted_cash":19.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LORAZEPAM INTENSOL 2 MG/ML PO CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00054353244","type":"NDC"}],"standard_charges":[{"gross_charge":4.85,"discounted_cash":4.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"FT MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70677111101","type":"NDC"}],"standard_charges":[{"gross_charge":26.06,"discounted_cash":26.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"CITROMA 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00869016638","type":"NDC"}],"standard_charges":[{"gross_charge":21.97,"discounted_cash":21.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"GNP MAGNESIUM CITRATE 1.745 GM/30ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"46122074138","type":"NDC"}],"standard_charges":[{"gross_charge":140.69,"discounted_cash":140.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 296 ML"}]},{"description":"SSKI 1 GM/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71740011230","type":"NDC"}],"standard_charges":[{"gross_charge":19.59,"discounted_cash":19.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"SORE THROAT SPRAY 1.4 % MT LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904630521","type":"NDC"}],"standard_charges":[{"gross_charge":2.17,"discounted_cash":2.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FE-VITE IRON 75 (15 FE) MG/ML PO SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71399748005","type":"NDC"}],"standard_charges":[{"gross_charge":7.68,"discounted_cash":7.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.867 ML"}]},{"description":"TRUEPLUS GLUCOSE 15 GM/32ML PO GEL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"56151162501","type":"NDC"}],"standard_charges":[{"gross_charge":43.06,"discounted_cash":43.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 64 ML"}]},{"description":"PULMICORT 0.25 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00186198804","type":"NDC"}],"standard_charges":[{"gross_charge":104.93,"discounted_cash":104.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PRED MILD 0.12 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"11980017405","type":"NDC"}],"standard_charges":[{"gross_charge":709.54,"discounted_cash":709.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ACTIDOSE-AQUA 25 GM/120ML PO LIQD","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00574052174","type":"NDC"}],"standard_charges":[{"gross_charge":220.68,"discounted_cash":220.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 240 ML"}]},{"description":"REFRESH TEARS 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00023079815","type":"NDC"}],"standard_charges":[{"gross_charge":101.37,"discounted_cash":101.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"PHENYLEPHRINE HCL 10 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"70756061430","type":"NDC"}],"standard_charges":[{"gross_charge":246.88,"discounted_cash":246.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MOXIFLOXACIN HCL 0.5 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"16714064301","type":"NDC"}],"standard_charges":[{"gross_charge":327.25,"discounted_cash":327.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"BUDESONIDE 0.25 MG/2ML IN SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00093681573","type":"NDC"}],"standard_charges":[{"gross_charge":91.32,"discounted_cash":91.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PREDNISOLONE SODIUM PHOSPHATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208071510","type":"NDC"}],"standard_charges":[{"gross_charge":340.66,"discounted_cash":340.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DESMOPRESSIN ACETATE SPRAY 0.01 % NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60505081500","type":"NDC"}],"standard_charges":[{"gross_charge":333.08,"discounted_cash":333.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TOBRAMYCIN-DEXAMETHASONE 0.3-0.1 % OP SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"24208029525","type":"NDC"}],"standard_charges":[{"gross_charge":163.2,"discounted_cash":163.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ATROPINE SULFATE 1 % OP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"60219174802","type":"NDC"}],"standard_charges":[{"gross_charge":233.05,"discounted_cash":233.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MARGENZA 250 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9353","type":"HCPCS"},{"code":"74527002202","type":"NDC"}],"standard_charges":[{"gross_charge":38731.16,"discounted_cash":38731.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 54 ML"}]},{"description":"RIABNI 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5123","type":"HCPCS"},{"code":"55513022401","type":"NDC"}],"standard_charges":[{"gross_charge":3381.13,"discounted_cash":3381.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"HAVRIX 1440 EL U/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"58160082652","type":"NDC"}],"standard_charges":[{"gross_charge":180.19,"discounted_cash":180.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"36000032010","type":"NDC"}],"standard_charges":[{"gross_charge":21.58,"discounted_cash":21.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036019","type":"NDC"}],"standard_charges":[{"gross_charge":57.58,"discounted_cash":57.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018301","type":"NDC"}],"standard_charges":[{"gross_charge":43.23,"discounted_cash":43.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.801 ML"}]},{"description":"GEMCITABINE HCL 200 MG/5.26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288011706","type":"NDC"}],"standard_charges":[{"gross_charge":56.43,"discounted_cash":56.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"00781331780","type":"NDC"}],"standard_charges":[{"gross_charge":129.22,"discounted_cash":129.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001910","type":"NDC"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":47.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"VANCOMYCIN HCL IN NACL 1.5-0.9 GM/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092905605","type":"NDC"}],"standard_charges":[{"gross_charge":202.46,"discounted_cash":202.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457026510","type":"NDC"}],"standard_charges":[{"gross_charge":106.83,"discounted_cash":106.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"00143959425","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"discounted_cash":16.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230505","type":"NDC"}],"standard_charges":[{"gross_charge":14.2,"discounted_cash":14.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409428202","type":"NDC"}],"standard_charges":[{"gross_charge":14.73,"discounted_cash":14.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CEFAZOLIN IN SODIUM CHLORIDE 3-0.9 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"70092162303","type":"NDC"}],"standard_charges":[{"gross_charge":146.38,"discounted_cash":146.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"71288020305","type":"NDC"}],"standard_charges":[{"gross_charge":20.41,"discounted_cash":20.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"64253040091","type":"NDC"}],"standard_charges":[{"gross_charge":41.29,"discounted_cash":41.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006225","type":"NDC"}],"standard_charges":[{"gross_charge":58.41,"discounted_cash":58.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116201","type":"NDC"}],"standard_charges":[{"gross_charge":17.31,"discounted_cash":17.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016205","type":"NDC"}],"standard_charges":[{"gross_charge":13.83,"discounted_cash":13.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047341","type":"NDC"}],"standard_charges":[{"gross_charge":27.63,"discounted_cash":27.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338171540","type":"NDC"}],"standard_charges":[{"gross_charge":58.09,"discounted_cash":58.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"00781927495","type":"NDC"}],"standard_charges":[{"gross_charge":87.71,"discounted_cash":87.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"VANCOMYCIN HCL 1750 MG/350ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005802","type":"NDC"}],"standard_charges":[{"gross_charge":171.54,"discounted_cash":171.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 600-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338954924","type":"NDC"}],"standard_charges":[{"gross_charge":56.14,"discounted_cash":56.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"NITROGLYCERIN IN D5W 100-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"00338104702","type":"NDC"}],"standard_charges":[{"gross_charge":17.98,"discounted_cash":17.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457025510","type":"NDC"}],"standard_charges":[{"gross_charge":140.63,"discounted_cash":140.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409469924","type":"NDC"}],"standard_charges":[{"gross_charge":15.03,"discounted_cash":15.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.317 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338361624","type":"NDC"}],"standard_charges":[{"gross_charge":56.14,"discounted_cash":56.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002310","type":"NDC"}],"standard_charges":[{"gross_charge":21.94,"discounted_cash":21.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"VANCOMYCIN HCL IN NACL 1.25-0.9 GM/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70092905405","type":"NDC"}],"standard_charges":[{"gross_charge":186.28,"discounted_cash":186.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"72266015201","type":"NDC"}],"standard_charges":[{"gross_charge":167.95,"discounted_cash":167.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066401","type":"NDC"}],"standard_charges":[{"gross_charge":14.18,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"72205010107","type":"NDC"}],"standard_charges":[{"gross_charge":41.49,"discounted_cash":41.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"23155024041","type":"NDC"}],"standard_charges":[{"gross_charge":19.3,"discounted_cash":19.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409672923","type":"NDC"}],"standard_charges":[{"gross_charge":82.72,"discounted_cash":82.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010626","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":74.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096520","type":"NDC"}],"standard_charges":[{"gross_charge":35.89,"discounted_cash":35.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016830","type":"NDC"}],"standard_charges":[{"gross_charge":39.43,"discounted_cash":39.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034543","type":"NDC"}],"standard_charges":[{"gross_charge":120.01,"discounted_cash":120.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034544","type":"NDC"}],"standard_charges":[{"gross_charge":14.33,"discounted_cash":14.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028010","type":"NDC"}],"standard_charges":[{"gross_charge":16.62,"discounted_cash":16.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00069020910","type":"NDC"}],"standard_charges":[{"gross_charge":14.49,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 1-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00338107302","type":"NDC"}],"standard_charges":[{"gross_charge":319.3,"discounted_cash":319.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 750 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409601025","type":"NDC"}],"standard_charges":[{"gross_charge":24.98,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.4 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006325","type":"NDC"}],"standard_charges":[{"gross_charge":18.42,"discounted_cash":18.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"LEVETIRACETAM IN NACL 1500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050310","type":"NDC"}],"standard_charges":[{"gross_charge":113.81,"discounted_cash":113.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792209","type":"NDC"}],"standard_charges":[{"gross_charge":81.01,"discounted_cash":81.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00990792903","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"55150030724","type":"NDC"}],"standard_charges":[{"gross_charge":74.75,"discounted_cash":74.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0137","type":"HCPCS"},{"code":"00143938610","type":"NDC"}],"standard_charges":[{"gross_charge":68.68,"discounted_cash":68.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613206","type":"NDC"}],"standard_charges":[{"gross_charge":37.89,"discounted_cash":37.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"67457042612","type":"NDC"}],"standard_charges":[{"gross_charge":13.14,"discounted_cash":13.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"GEMCITABINE HCL 2 GM/52.6ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018201","type":"NDC"}],"standard_charges":[{"gross_charge":94.54,"discounted_cash":94.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.2 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150017705","type":"NDC"}],"standard_charges":[{"gross_charge":24.55,"discounted_cash":24.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"55150032225","type":"NDC"}],"standard_charges":[{"gross_charge":17.15,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323073912","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"55150022310","type":"NDC"}],"standard_charges":[{"gross_charge":31.43,"discounted_cash":31.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"63323073916","type":"NDC"}],"standard_charges":[{"gross_charge":18.75,"discounted_cash":18.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"31722020331","type":"NDC"}],"standard_charges":[{"gross_charge":54.29,"discounted_cash":54.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"71288071610","type":"NDC"}],"standard_charges":[{"gross_charge":45.34,"discounted_cash":45.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"71288010110","type":"NDC"}],"standard_charges":[{"gross_charge":42.44,"discounted_cash":42.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"72603041225","type":"NDC"}],"standard_charges":[{"gross_charge":26.75,"discounted_cash":26.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CHLOROPROCAINE HCL (PF) 3 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"00143921010","type":"NDC"}],"standard_charges":[{"gross_charge":26.57,"discounted_cash":26.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338170940","type":"NDC"}],"standard_charges":[{"gross_charge":38.94,"discounted_cash":38.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"KCL-LACTATED RINGERS-D5W 20 MEQ/L IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711109","type":"NDC"}],"standard_charges":[{"gross_charge":92.27,"discounted_cash":92.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"00409780922","type":"NDC"}],"standard_charges":[{"gross_charge":116.65,"discounted_cash":116.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972124","type":"NDC"}],"standard_charges":[{"gross_charge":48.7,"discounted_cash":48.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"65219047905","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 10-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264763400","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264765200","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001748","type":"NDC"}],"standard_charges":[{"gross_charge":32.78,"discounted_cash":32.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00409444424","type":"NDC"}],"standard_charges":[{"gross_charge":59.94,"discounted_cash":59.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00338012504","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121172009","type":"NDC"}],"standard_charges":[{"gross_charge":61.8,"discounted_cash":61.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409672723","type":"NDC"}],"standard_charges":[{"gross_charge":59.94,"discounted_cash":59.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323051774","type":"NDC"}],"standard_charges":[{"gross_charge":70.69,"discounted_cash":70.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070948","type":"NDC"}],"standard_charges":[{"gross_charge":82.16,"discounted_cash":82.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042124","type":"NDC"}],"standard_charges":[{"gross_charge":78.45,"discounted_cash":78.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"25021061281","type":"NDC"}],"standard_charges":[{"gross_charge":47.73,"discounted_cash":47.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021019287","type":"NDC"}],"standard_charges":[{"gross_charge":77.71,"discounted_cash":77.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264151031","type":"NDC"}],"standard_charges":[{"gross_charge":30.38,"discounted_cash":30.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00990792323","type":"NDC"}],"standard_charges":[{"gross_charge":30.38,"discounted_cash":30.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"83634050081","type":"NDC"}],"standard_charges":[{"gross_charge":41.38,"discounted_cash":41.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"VANCOMYCIN HCL 1000 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004203","type":"NDC"}],"standard_charges":[{"gross_charge":104.68,"discounted_cash":104.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042424","type":"NDC"}],"standard_charges":[{"gross_charge":72.9,"discounted_cash":72.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028425","type":"NDC"}],"standard_charges":[{"gross_charge":31.38,"discounted_cash":31.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050210","type":"NDC"}],"standard_charges":[{"gross_charge":89.74,"discounted_cash":89.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070341","type":"NDC"}],"standard_charges":[{"gross_charge":79.38,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00409610210","type":"NDC"}],"standard_charges":[{"gross_charge":21.85,"discounted_cash":21.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"VANCOMYCIN HCL IN NACL 1.75-0.9 GM/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70004092644","type":"NDC"}],"standard_charges":[{"gross_charge":342.67,"discounted_cash":342.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264751000","type":"NDC"}],"standard_charges":[{"gross_charge":58.14,"discounted_cash":58.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 850 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792203","type":"NDC"}],"standard_charges":[{"gross_charge":93.11,"discounted_cash":93.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00990795309","type":"NDC"}],"standard_charges":[{"gross_charge":23.19,"discounted_cash":23.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001738","type":"NDC"}],"standard_charges":[{"gross_charge":51.53,"discounted_cash":51.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010826","type":"NDC"}],"standard_charges":[{"gross_charge":52.54,"discounted_cash":52.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010801","type":"NDC"}],"standard_charges":[{"gross_charge":52.54,"discounted_cash":52.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264763500","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792313","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 75 ML"}]},{"description":"ONIVYDE 43 MG/10ML IV INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9205","type":"HCPCS"},{"code":"15054004301","type":"NDC"}],"standard_charges":[{"gross_charge":3462.4,"discounted_cash":3462.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"RITUXAN 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9312","type":"HCPCS"},{"code":"50242005306","type":"NDC"}],"standard_charges":[{"gross_charge":15006.13,"discounted_cash":15006.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427801","type":"NDC"}],"standard_charges":[{"gross_charge":13.34,"discounted_cash":13.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070548","type":"NDC"}],"standard_charges":[{"gross_charge":21.77,"discounted_cash":21.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.139 ML"}]},{"description":"GENTAMICIN IN SALINE 0.8-0.9 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"00338050348","type":"NDC"}],"standard_charges":[{"gross_charge":80.31,"discounted_cash":80.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409452030","type":"NDC"}],"standard_charges":[{"gross_charge":98.27,"discounted_cash":98.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"69784000306","type":"NDC"}],"standard_charges":[{"gross_charge":79.71,"discounted_cash":79.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001741","type":"NDC"}],"standard_charges":[{"gross_charge":59.35,"discounted_cash":59.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00338001731","type":"NDC"}],"standard_charges":[{"gross_charge":54.46,"discounted_cash":54.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VANCOMYCIN HCL 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005603","type":"NDC"}],"standard_charges":[{"gross_charge":107.29,"discounted_cash":107.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"67457094010","type":"NDC"}],"standard_charges":[{"gross_charge":76.7,"discounted_cash":76.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150017030","type":"NDC"}],"standard_charges":[{"gross_charge":30.8,"discounted_cash":30.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050190","type":"NDC"}],"standard_charges":[{"gross_charge":59.94,"discounted_cash":59.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096510","type":"NDC"}],"standard_charges":[{"gross_charge":29.97,"discounted_cash":29.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VANCOMYCIN HCL 1500 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004302","type":"NDC"}],"standard_charges":[{"gross_charge":149.25,"discounted_cash":149.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"43598063610","type":"NDC"}],"standard_charges":[{"gross_charge":103.96,"discounted_cash":103.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"OCTAGAM 10 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085003","type":"NDC"}],"standard_charges":[{"gross_charge":3466.04,"discounted_cash":3466.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"OCTAGAM 20 GM/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085004","type":"NDC"}],"standard_charges":[{"gross_charge":6919.67,"discounted_cash":6919.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ZARXIO 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314031810","type":"NDC"}],"standard_charges":[{"gross_charge":472.91,"discounted_cash":472.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ZARXIO 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032601","type":"NDC"}],"standard_charges":[{"gross_charge":749.23,"discounted_cash":749.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ZARXIO 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5101","type":"HCPCS"},{"code":"61314032610","type":"NDC"}],"standard_charges":[{"gross_charge":749.21,"discounted_cash":749.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"NEULASTA 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019001","type":"NDC"}],"standard_charges":[{"gross_charge":16203.54,"discounted_cash":16203.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"NEULASTA ONPRO 6 MG/0.6ML SC PSKT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2506","type":"HCPCS"},{"code":"55513019201","type":"NDC"}],"standard_charges":[{"gross_charge":10794.83,"discounted_cash":10794.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"NEUPOGEN 300 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513092491","type":"NDC"}],"standard_charges":[{"gross_charge":1121.1,"discounted_cash":1121.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"NEUPOGEN 480 MCG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1442","type":"HCPCS"},{"code":"55513020991","type":"NDC"}],"standard_charges":[{"gross_charge":1776.26,"discounted_cash":1776.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 40 MCG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002104","type":"NDC"}],"standard_charges":[{"gross_charge":557.57,"discounted_cash":557.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 60 MCG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002304","type":"NDC"}],"standard_charges":[{"gross_charge":830.16,"discounted_cash":830.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 150 MCG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002704","type":"NDC"}],"standard_charges":[{"gross_charge":2056.76,"discounted_cash":2056.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 200 MCG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002801","type":"NDC"}],"standard_charges":[{"gross_charge":2738.22,"discounted_cash":2738.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 300 MCG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513011101","type":"NDC"}],"standard_charges":[{"gross_charge":2056.76,"discounted_cash":2056.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 500 MCG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513003201","type":"NDC"}],"standard_charges":[{"gross_charge":7257.62,"discounted_cash":7257.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ARANESP (ALBUMIN FREE) 100 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0881","type":"HCPCS"},{"code":"55513002504","type":"NDC"}],"standard_charges":[{"gross_charge":557.57,"discounted_cash":557.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"55150024447","type":"NDC"}],"standard_charges":[{"gross_charge":52.54,"discounted_cash":52.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 200-0.9 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018482","type":"NDC"}],"standard_charges":[{"gross_charge":57.17,"discounted_cash":57.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264420654","type":"NDC"}],"standard_charges":[{"gross_charge":38.52,"discounted_cash":38.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972024","type":"NDC"}],"standard_charges":[{"gross_charge":50.66,"discounted_cash":50.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338067104","type":"NDC"}],"standard_charges":[{"gross_charge":93.11,"discounted_cash":93.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00409412150","type":"NDC"}],"standard_charges":[{"gross_charge":72.9,"discounted_cash":72.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323052374","type":"NDC"}],"standard_charges":[{"gross_charge":88.24,"discounted_cash":88.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"36000030660","type":"NDC"}],"standard_charges":[{"gross_charge":64.67,"discounted_cash":64.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0134","type":"HCPCS"},{"code":"63323043400","type":"NDC"}],"standard_charges":[{"gross_charge":38.71,"discounted_cash":38.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18.1 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00338170840","type":"NDC"}],"standard_charges":[{"gross_charge":76.6,"discounted_cash":76.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"70121171909","type":"NDC"}],"standard_charges":[{"gross_charge":75.68,"discounted_cash":75.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409427902","type":"NDC"}],"standard_charges":[{"gross_charge":13.16,"discounted_cash":13.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409471302","type":"NDC"}],"standard_charges":[{"gross_charge":20.55,"discounted_cash":20.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409318301","type":"NDC"}],"standard_charges":[{"gross_charge":16.09,"discounted_cash":16.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00338107502","type":"NDC"}],"standard_charges":[{"gross_charge":268.33,"discounted_cash":268.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"55150032325","type":"NDC"}],"standard_charges":[{"gross_charge":22.82,"discounted_cash":22.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775000","type":"NDC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":14.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116501","type":"NDC"}],"standard_charges":[{"gross_charge":19.8,"discounted_cash":19.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007951","type":"NDC"}],"standard_charges":[{"gross_charge":692.3,"discounted_cash":692.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 545 ML"}]},{"description":"ESMOLOL HCL-SODIUM CHLORIDE 2500 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"25021030884","type":"NDC"}],"standard_charges":[{"gross_charge":450.52,"discounted_cash":450.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"80830236209","type":"NDC"}],"standard_charges":[{"gross_charge":119.06,"discounted_cash":119.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"71351002110","type":"NDC"}],"standard_charges":[{"gross_charge":32.26,"discounted_cash":32.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"MIDAZOLAM HCL (PF) 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409000125","type":"NDC"}],"standard_charges":[{"gross_charge":25.41,"discounted_cash":25.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"63323036059","type":"NDC"}],"standard_charges":[{"gross_charge":67.32,"discounted_cash":67.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080605","type":"NDC"}],"standard_charges":[{"gross_charge":17.0,"discounted_cash":17.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"25021031102","type":"NDC"}],"standard_charges":[{"gross_charge":29.16,"discounted_cash":29.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MIDAZOLAM HCL (PF) 10 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230802","type":"NDC"}],"standard_charges":[{"gross_charge":22.66,"discounted_cash":22.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409341401","type":"NDC"}],"standard_charges":[{"gross_charge":17.02,"discounted_cash":17.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00781329009","type":"NDC"}],"standard_charges":[{"gross_charge":102.78,"discounted_cash":102.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007959","type":"NDC"}],"standard_charges":[{"gross_charge":811.68,"discounted_cash":811.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 745 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"25021060820","type":"NDC"}],"standard_charges":[{"gross_charge":17.15,"discounted_cash":17.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00409665106","type":"NDC"}],"standard_charges":[{"gross_charge":40.6,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00990794109","type":"NDC"}],"standard_charges":[{"gross_charge":93.11,"discounted_cash":93.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00990792909","type":"NDC"}],"standard_charges":[{"gross_charge":93.11,"discounted_cash":93.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775007","type":"NDC"}],"standard_charges":[{"gross_charge":47.62,"discounted_cash":47.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 900 ML"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9290","type":"HCPCS"},{"code":"65250026609","type":"NDC"}],"standard_charges":[{"gross_charge":427.11,"discounted_cash":427.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9290","type":"HCPCS"},{"code":"65250013309","type":"NDC"}],"standard_charges":[{"gross_charge":369.54,"discounted_cash":369.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9290","type":"HCPCS"},{"code":"65250013304","type":"NDC"}],"standard_charges":[{"gross_charge":369.54,"discounted_cash":369.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"RELISTOR 8 MG/0.4ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2212","type":"HCPCS"},{"code":"65649055204","type":"NDC"}],"standard_charges":[{"gross_charge":416.27,"discounted_cash":416.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"VYVGART HYTRULO 180-2000 MG-UNIT/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9334","type":"HCPCS"},{"code":"73475310203","type":"NDC"}],"standard_charges":[{"gross_charge":53885.09,"discounted_cash":53885.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.6 ML"}]},{"description":"COSENTYX 125 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3247","type":"HCPCS"},{"code":"00078116861","type":"NDC"}],"standard_charges":[{"gross_charge":7381.4,"discounted_cash":7381.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ALBUKED 5 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"76125079025","type":"NDC"}],"standard_charges":[{"gross_charge":242.92,"discounted_cash":242.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521409","type":"NDC"}],"standard_charges":[{"gross_charge":261.07,"discounted_cash":261.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521402","type":"NDC"}],"standard_charges":[{"gross_charge":701.03,"discounted_cash":701.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"FLEXBUMIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"00944049505","type":"NDC"}],"standard_charges":[{"gross_charge":324.59,"discounted_cash":324.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010910","type":"NDC"}],"standard_charges":[{"gross_charge":246.32,"discounted_cash":246.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"65282160501","type":"NDC"}],"standard_charges":[{"gross_charge":26.52,"discounted_cash":26.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ACYCLOVIR SODIUM 50 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0133","type":"HCPCS"},{"code":"63323032524","type":"NDC"}],"standard_charges":[{"gross_charge":37.31,"discounted_cash":37.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021082682","type":"NDC"}],"standard_charges":[{"gross_charge":182.33,"discounted_cash":182.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409206605","type":"NDC"}],"standard_charges":[{"gross_charge":13.56,"discounted_cash":13.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"14789010810","type":"NDC"}],"standard_charges":[{"gross_charge":265.01,"discounted_cash":265.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ROPIVACAINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006710","type":"NDC"}],"standard_charges":[{"gross_charge":42.52,"discounted_cash":42.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FLUOROURACIL 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011710","type":"NDC"}],"standard_charges":[{"gross_charge":65.59,"discounted_cash":65.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"FLUOROURACIL 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011718","type":"NDC"}],"standard_charges":[{"gross_charge":65.59,"discounted_cash":65.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"CEFAZOLIN SODIUM-DEXTROSE 2-3 GM-%(50ML) IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"00264310511","type":"NDC"}],"standard_charges":[{"gross_charge":65.42,"discounted_cash":65.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2001","type":"HCPCS"},{"code":"63323020805","type":"NDC"}],"standard_charges":[{"gross_charge":37.58,"discounted_cash":37.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"25021031104","type":"NDC"}],"standard_charges":[{"gross_charge":23.79,"discounted_cash":23.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043624","type":"NDC"}],"standard_charges":[{"gross_charge":98.21,"discounted_cash":98.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028036","type":"NDC"}],"standard_charges":[{"gross_charge":17.54,"discounted_cash":17.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707714","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":63.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"70069081710","type":"NDC"}],"standard_charges":[{"gross_charge":15.79,"discounted_cash":15.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047344","type":"NDC"}],"standard_charges":[{"gross_charge":25.27,"discounted_cash":25.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"44567042024","type":"NDC"}],"standard_charges":[{"gross_charge":77.71,"discounted_cash":77.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00264775110","type":"NDC"}],"standard_charges":[{"gross_charge":24.39,"discounted_cash":24.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409115901","type":"NDC"}],"standard_charges":[{"gross_charge":16.99,"discounted_cash":16.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"63323065210","type":"NDC"}],"standard_charges":[{"gross_charge":40.67,"discounted_cash":40.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9.5 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457055300","type":"NDC"}],"standard_charges":[{"gross_charge":98.21,"discounted_cash":98.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ROPIVACAINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066002710","type":"NDC"}],"standard_charges":[{"gross_charge":78.26,"discounted_cash":78.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"25021067187","type":"NDC"}],"standard_charges":[{"gross_charge":224.4,"discounted_cash":224.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 600 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00781328909","type":"NDC"}],"standard_charges":[{"gross_charge":83.08,"discounted_cash":83.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"65219016210","type":"NDC"}],"standard_charges":[{"gross_charge":88.24,"discounted_cash":88.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"55150024747","type":"NDC"}],"standard_charges":[{"gross_charge":160.76,"discounted_cash":160.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"55150019410","type":"NDC"}],"standard_charges":[{"gross_charge":13.53,"discounted_cash":13.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00143959525","type":"NDC"}],"standard_charges":[{"gross_charge":13.15,"discounted_cash":13.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.18 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028002","type":"NDC"}],"standard_charges":[{"gross_charge":15.27,"discounted_cash":15.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"67457043322","type":"NDC"}],"standard_charges":[{"gross_charge":18.01,"discounted_cash":18.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150017110","type":"NDC"}],"standard_charges":[{"gross_charge":23.47,"discounted_cash":23.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"73177010914","type":"NDC"}],"standard_charges":[{"gross_charge":860.01,"discounted_cash":860.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 745 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"00641255510","type":"NDC"}],"standard_charges":[{"gross_charge":46.95,"discounted_cash":46.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"70069010105","type":"NDC"}],"standard_charges":[{"gross_charge":38.73,"discounted_cash":38.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"73177010913","type":"NDC"}],"standard_charges":[{"gross_charge":831.72,"discounted_cash":831.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 545 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"68462046954","type":"NDC"}],"standard_charges":[{"gross_charge":31.1,"discounted_cash":31.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"43598083936","type":"NDC"}],"standard_charges":[{"gross_charge":46.01,"discounted_cash":46.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457061730","type":"NDC"}],"standard_charges":[{"gross_charge":150.97,"discounted_cash":150.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.599 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040302","type":"NDC"}],"standard_charges":[{"gross_charge":21.93,"discounted_cash":21.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641602725","type":"NDC"}],"standard_charges":[{"gross_charge":15.89,"discounted_cash":15.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"CHLOROPROCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"00143920910","type":"NDC"}],"standard_charges":[{"gross_charge":40.76,"discounted_cash":40.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016910","type":"NDC"}],"standard_charges":[{"gross_charge":37.66,"discounted_cash":37.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL (PF) 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016505","type":"NDC"}],"standard_charges":[{"gross_charge":16.64,"discounted_cash":16.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909461","type":"NDC"}],"standard_charges":[{"gross_charge":76.67,"discounted_cash":76.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00338011704","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":79.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"HEPARIN SOD (PORCINE) IN D5W 100 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00264958720","type":"NDC"}],"standard_charges":[{"gross_charge":20.28,"discounted_cash":20.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8.525 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264151032","type":"NDC"}],"standard_charges":[{"gross_charge":21.4,"discounted_cash":21.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.9 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338080304","type":"NDC"}],"standard_charges":[{"gross_charge":85.01,"discounted_cash":85.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CL IN DEXTROSE 5% 20 MEQ/L IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264762500","type":"NDC"}],"standard_charges":[{"gross_charge":85.01,"discounted_cash":85.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"25021011487","type":"NDC"}],"standard_charges":[{"gross_charge":75.7,"discounted_cash":75.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00143972224","type":"NDC"}],"standard_charges":[{"gross_charge":42.85,"discounted_cash":42.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028026","type":"NDC"}],"standard_charges":[{"gross_charge":19.21,"discounted_cash":19.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409765030","type":"NDC"}],"standard_charges":[{"gross_charge":27.54,"discounted_cash":27.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.956 ML"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006411","type":"NDC"}],"standard_charges":[{"gross_charge":18.19,"discounted_cash":18.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409525515","type":"NDC"}],"standard_charges":[{"gross_charge":21.62,"discounted_cash":21.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ROPIVACAINE HCL-NACL 0.2-0.9 % (ON-Q) IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"71449007957","type":"NDC"}],"standard_charges":[{"gross_charge":340.56,"discounted_cash":340.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028225","type":"NDC"}],"standard_charges":[{"gross_charge":17.52,"discounted_cash":17.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641603001","type":"NDC"}],"standard_charges":[{"gross_charge":91.19,"discounted_cash":91.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016102","type":"NDC"}],"standard_charges":[{"gross_charge":21.59,"discounted_cash":21.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"72603010101","type":"NDC"}],"standard_charges":[{"gross_charge":139.31,"discounted_cash":139.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15.5 ML"}]},{"description":"EPTIFIBATIDE 75 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"70436016380","type":"NDC"}],"standard_charges":[{"gross_charge":266.69,"discounted_cash":266.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00338007225","type":"NDC"}],"standard_charges":[{"gross_charge":17.7,"discounted_cash":17.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00409610204","type":"NDC"}],"standard_charges":[{"gross_charge":32.95,"discounted_cash":32.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016216","type":"NDC"}],"standard_charges":[{"gross_charge":19.71,"discounted_cash":19.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PHENYTOIN SODIUM 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1165","type":"HCPCS"},{"code":"00641049325","type":"NDC"}],"standard_charges":[{"gross_charge":32.58,"discounted_cash":32.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00409665305","type":"NDC"}],"standard_charges":[{"gross_charge":40.49,"discounted_cash":40.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FAMOTIDINE (PF) 20 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1308","type":"HCPCS"},{"code":"00641602225","type":"NDC"}],"standard_charges":[{"gross_charge":24.21,"discounted_cash":24.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028016","type":"NDC"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":18.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"71288020303","type":"NDC"}],"standard_charges":[{"gross_charge":23.19,"discounted_cash":23.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FLUOROURACIL 1 GM/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011720","type":"NDC"}],"standard_charges":[{"gross_charge":54.65,"discounted_cash":54.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL 2 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"23155060041","type":"NDC"}],"standard_charges":[{"gross_charge":21.89,"discounted_cash":21.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011925","type":"NDC"}],"standard_charges":[{"gross_charge":16.21,"discounted_cash":16.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"63323040044","type":"NDC"}],"standard_charges":[{"gross_charge":30.91,"discounted_cash":30.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"60505613207","type":"NDC"}],"standard_charges":[{"gross_charge":36.53,"discounted_cash":36.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FENTANYL CITRATE (PF) 250 MCG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909425","type":"NDC"}],"standard_charges":[{"gross_charge":14.85,"discounted_cash":14.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016226","type":"NDC"}],"standard_charges":[{"gross_charge":21.5,"discounted_cash":21.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 1-0.675 GM/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0613","type":"HCPCS"},{"code":"44567062024","type":"NDC"}],"standard_charges":[{"gross_charge":93.75,"discounted_cash":93.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"67457079005","type":"NDC"}],"standard_charges":[{"gross_charge":25.88,"discounted_cash":25.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"23155047342","type":"NDC"}],"standard_charges":[{"gross_charge":17.06,"discounted_cash":17.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"72603025101","type":"NDC"}],"standard_charges":[{"gross_charge":29.43,"discounted_cash":29.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016202","type":"NDC"}],"standard_charges":[{"gross_charge":15.41,"discounted_cash":15.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.33 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"25021083082","type":"NDC"}],"standard_charges":[{"gross_charge":294.49,"discounted_cash":294.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457079410","type":"NDC"}],"standard_charges":[{"gross_charge":278.67,"discounted_cash":278.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00409341411","type":"NDC"}],"standard_charges":[{"gross_charge":21.85,"discounted_cash":21.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006403","type":"NDC"}],"standard_charges":[{"gross_charge":30.99,"discounted_cash":30.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323051877","type":"NDC"}],"standard_charges":[{"gross_charge":85.73,"discounted_cash":85.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"FLUCONAZOLE IN SODIUM CHLORIDE 400-0.9 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1450","type":"HCPCS"},{"code":"25021018487","type":"NDC"}],"standard_charges":[{"gross_charge":67.68,"discounted_cash":67.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"LEVOFLOXACIN IN D5W 750 MG/150ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043724","type":"NDC"}],"standard_charges":[{"gross_charge":79.38,"discounted_cash":79.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"PROCRIT 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676034001","type":"NDC"}],"standard_charges":[{"gross_charge":971.34,"discounted_cash":971.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POTASSIUM CHLORIDE 10 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707426","type":"NDC"}],"standard_charges":[{"gross_charge":62.66,"discounted_cash":62.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"00264410090","type":"NDC"}],"standard_charges":[{"gross_charge":44.28,"discounted_cash":44.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.45 ML"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013281","type":"NDC"}],"standard_charges":[{"gross_charge":82.16,"discounted_cash":82.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"VANCOMYCIN HCL 2000 MG/400ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594004402","type":"NDC"}],"standard_charges":[{"gross_charge":193.83,"discounted_cash":193.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 400 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010705","type":"NDC"}],"standard_charges":[{"gross_charge":68.27,"discounted_cash":68.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"24201010024","type":"NDC"}],"standard_charges":[{"gross_charge":64.57,"discounted_cash":64.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN NACL 900-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338955324","type":"NDC"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PROPOFOL 500 MG/50ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00409469933","type":"NDC"}],"standard_charges":[{"gross_charge":14.91,"discounted_cash":14.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.27 ML"}]},{"description":"ACETAMINOPHEN 500 MG/50 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0136","type":"HCPCS"},{"code":"00264405080","type":"NDC"}],"standard_charges":[{"gross_charge":55.64,"discounted_cash":55.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775020","type":"NDC"}],"standard_charges":[{"gross_charge":14.33,"discounted_cash":14.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00338011703","type":"NDC"}],"standard_charges":[{"gross_charge":51.53,"discounted_cash":51.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"KCL IN DEXTROSE-NACL 20-5-0.45 MEQ/L-%-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990790209","type":"NDC"}],"standard_charges":[{"gross_charge":120.01,"discounted_cash":120.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"DURACLON 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"67457021810","type":"NDC"}],"standard_charges":[{"gross_charge":25.31,"discounted_cash":25.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792202","type":"NDC"}],"standard_charges":[{"gross_charge":21.99,"discounted_cash":21.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046417","type":"NDC"}],"standard_charges":[{"gross_charge":14.21,"discounted_cash":14.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150012150","type":"NDC"}],"standard_charges":[{"gross_charge":83.08,"discounted_cash":83.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"44567080310","type":"NDC"}],"standard_charges":[{"gross_charge":60.26,"discounted_cash":60.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00781311495","type":"NDC"}],"standard_charges":[{"gross_charge":55.73,"discounted_cash":55.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"70594008202","type":"NDC"}],"standard_charges":[{"gross_charge":81.47,"discounted_cash":81.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 50 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016010","type":"NDC"}],"standard_charges":[{"gross_charge":137.78,"discounted_cash":137.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457052810","type":"NDC"}],"standard_charges":[{"gross_charge":137.48,"discounted_cash":137.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"68001041737","type":"NDC"}],"standard_charges":[{"gross_charge":582.56,"discounted_cash":582.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"43598090158","type":"NDC"}],"standard_charges":[{"gross_charge":164.22,"discounted_cash":164.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"25021015120","type":"NDC"}],"standard_charges":[{"gross_charge":40.95,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00781311395","type":"NDC"}],"standard_charges":[{"gross_charge":68.87,"discounted_cash":68.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"00641611710","type":"NDC"}],"standard_charges":[{"gross_charge":73.05,"discounted_cash":73.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"65219025945","type":"NDC"}],"standard_charges":[{"gross_charge":72.2,"discounted_cash":72.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323028426","type":"NDC"}],"standard_charges":[{"gross_charge":48.5,"discounted_cash":48.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 UN"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049257","type":"NDC"}],"standard_charges":[{"gross_charge":13.65,"discounted_cash":13.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049297","type":"NDC"}],"standard_charges":[{"gross_charge":41.3,"discounted_cash":41.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049236","type":"NDC"}],"standard_charges":[{"gross_charge":14.14,"discounted_cash":14.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"25021025150","type":"NDC"}],"standard_charges":[{"gross_charge":280.95,"discounted_cash":280.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.26 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"39822019001","type":"NDC"}],"standard_charges":[{"gross_charge":152.71,"discounted_cash":152.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"67457085350","type":"NDC"}],"standard_charges":[{"gross_charge":107.34,"discounted_cash":107.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"71288011530","type":"NDC"}],"standard_charges":[{"gross_charge":187.48,"discounted_cash":187.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.267 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"23155083131","type":"NDC"}],"standard_charges":[{"gross_charge":65.45,"discounted_cash":65.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFAZOLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"60505623105","type":"NDC"}],"standard_charges":[{"gross_charge":46.19,"discounted_cash":46.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"CEFAZOLIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0688","type":"HCPCS"},{"code":"00143913925","type":"NDC"}],"standard_charges":[{"gross_charge":50.45,"discounted_cash":50.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFAZOLIN SODIUM 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0690","type":"HCPCS"},{"code":"44567084025","type":"NDC"}],"standard_charges":[{"gross_charge":52.74,"discounted_cash":52.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ERYTHROCIN LACTOBIONATE 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1364","type":"HCPCS"},{"code":"00409648201","type":"NDC"}],"standard_charges":[{"gross_charge":214.57,"discounted_cash":214.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"TROPIC-CYCLOPENT-PE-KETOROLAC 1-1-2.5-0.5 % OP SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"71266824001","type":"NDC"}],"standard_charges":[{"gross_charge":85.73,"discounted_cash":85.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ALBUTEROL SULFATE 2.5 MG/0.5ML IN NEBU","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00487990130","type":"NDC"}],"standard_charges":[{"gross_charge":10.81,"discounted_cash":10.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457053035","type":"NDC"}],"standard_charges":[{"gross_charge":109.18,"discounted_cash":109.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.331 UN"}]},{"description":"ASTRINGYN 259 MG/GM EX SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"59365606501","type":"NDC"}],"standard_charges":[{"gross_charge":107.35,"discounted_cash":107.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 GR"}]},{"description":"DESITIN 40 % EX PSTE","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"69968006102","type":"NDC"}],"standard_charges":[{"gross_charge":63.61,"discounted_cash":63.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 57 GR"}]},{"description":"ERYTHROMYCIN 5 MG/GM OP OINT","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"72485067031","type":"NDC"}],"standard_charges":[{"gross_charge":65.67,"discounted_cash":65.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 GR"}]},{"description":"MARCAINE PRESERVATIVE FREE 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409155910","type":"NDC"}],"standard_charges":[{"gross_charge":19.23,"discounted_cash":19.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046639","type":"NDC"}],"standard_charges":[{"gross_charge":14.45,"discounted_cash":14.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.4 ML"}]},{"description":"MARCAINE PRESERVATIVE FREE 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409156029","type":"NDC"}],"standard_charges":[{"gross_charge":15.53,"discounted_cash":15.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046638","type":"NDC"}],"standard_charges":[{"gross_charge":18.41,"discounted_cash":18.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046617","type":"NDC"}],"standard_charges":[{"gross_charge":14.35,"discounted_cash":14.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SENSORCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046637","type":"NDC"}],"standard_charges":[{"gross_charge":13.91,"discounted_cash":13.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LOVENOX 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801310","type":"NDC"}],"standard_charges":[{"gross_charge":46.62,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"LOVENOX 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801410","type":"NDC"}],"standard_charges":[{"gross_charge":38.58,"discounted_cash":38.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"LOVENOX 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062040","type":"NDC"}],"standard_charges":[{"gross_charge":38.58,"discounted_cash":38.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"LOVENOX 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062160","type":"NDC"}],"standard_charges":[{"gross_charge":28.12,"discounted_cash":28.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"FERRLECIT 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00024279410","type":"NDC"}],"standard_charges":[{"gross_charge":124.59,"discounted_cash":124.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FERRLECIT 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00024279210","type":"NDC"}],"standard_charges":[{"gross_charge":124.59,"discounted_cash":124.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049237","type":"NDC"}],"standard_charges":[{"gross_charge":12.78,"discounted_cash":12.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049226","type":"NDC"}],"standard_charges":[{"gross_charge":17.61,"discounted_cash":17.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00143928410","type":"NDC"}],"standard_charges":[{"gross_charge":34.17,"discounted_cash":34.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00143916210","type":"NDC"}],"standard_charges":[{"gross_charge":21.48,"discounted_cash":21.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"25021075110","type":"NDC"}],"standard_charges":[{"gross_charge":37.61,"discounted_cash":37.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFOXITIN SODIUM 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0694","type":"HCPCS"},{"code":"25021010910","type":"NDC"}],"standard_charges":[{"gross_charge":58.62,"discounted_cash":58.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070025","type":"NDC"}],"standard_charges":[{"gross_charge":29.73,"discounted_cash":29.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"JEVTANA 60 MG/1.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9043","type":"HCPCS"},{"code":"00024582411","type":"NDC"}],"standard_charges":[{"gross_charge":11724.47,"discounted_cash":11724.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.283 UN"}]},{"description":"ZITHROMAX 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"00069315083","type":"NDC"}],"standard_charges":[{"gross_charge":54.71,"discounted_cash":54.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"71288011810","type":"NDC"}],"standard_charges":[{"gross_charge":53.44,"discounted_cash":53.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.057 UN"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"55150033701","type":"NDC"}],"standard_charges":[{"gross_charge":784.9,"discounted_cash":784.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 2 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"72078006699","type":"NDC"}],"standard_charges":[{"gross_charge":213.82,"discounted_cash":213.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"25021024410","type":"NDC"}],"standard_charges":[{"gross_charge":99.71,"discounted_cash":99.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.086 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"00143939810","type":"NDC"}],"standard_charges":[{"gross_charge":128.64,"discounted_cash":128.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955301","type":"NDC"}],"standard_charges":[{"gross_charge":245.77,"discounted_cash":245.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016120","type":"NDC"}],"standard_charges":[{"gross_charge":286.76,"discounted_cash":286.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CHLOROTHIAZIDE SODIUM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1205","type":"HCPCS"},{"code":"63323065820","type":"NDC"}],"standard_charges":[{"gross_charge":75.62,"discounted_cash":75.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"CEFTRIAXONE SODIUM-DEXTROSE 2-2.22 GM-%(50ML) IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00264315511","type":"NDC"}],"standard_charges":[{"gross_charge":93.66,"discounted_cash":93.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"16729030610","type":"NDC"}],"standard_charges":[{"gross_charge":465.25,"discounted_cash":465.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.267 UN"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323020326","type":"NDC"}],"standard_charges":[{"gross_charge":47.98,"discounted_cash":47.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"44567080210","type":"NDC"}],"standard_charges":[{"gross_charge":58.32,"discounted_cash":58.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"68001050831","type":"NDC"}],"standard_charges":[{"gross_charge":83.04,"discounted_cash":83.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"44567021110","type":"NDC"}],"standard_charges":[{"gross_charge":106.2,"discounted_cash":106.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598030562","type":"NDC"}],"standard_charges":[{"gross_charge":267.75,"discounted_cash":267.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.745 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"68001041838","type":"NDC"}],"standard_charges":[{"gross_charge":215.35,"discounted_cash":215.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.586 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3371","type":"HCPCS"},{"code":"67457034001","type":"NDC"}],"standard_charges":[{"gross_charge":30.98,"discounted_cash":30.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 UN"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"55150017410","type":"NDC"}],"standard_charges":[{"gross_charge":46.71,"discounted_cash":46.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323020320","type":"NDC"}],"standard_charges":[{"gross_charge":47.52,"discounted_cash":47.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"71288002421","type":"NDC"}],"standard_charges":[{"gross_charge":51.93,"discounted_cash":51.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016230","type":"NDC"}],"standard_charges":[{"gross_charge":251.3,"discounted_cash":251.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081630","type":"NDC"}],"standard_charges":[{"gross_charge":64.15,"discounted_cash":64.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.143 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"72485020101","type":"NDC"}],"standard_charges":[{"gross_charge":226.5,"discounted_cash":226.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.267 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"60505619604","type":"NDC"}],"standard_charges":[{"gross_charge":155.01,"discounted_cash":155.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"72485041710","type":"NDC"}],"standard_charges":[{"gross_charge":58.3,"discounted_cash":58.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LIDOCAINE-EPINEPHRINE 1 %-1:100000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409317802","type":"NDC"}],"standard_charges":[{"gross_charge":42.96,"discounted_cash":42.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"60505615201","type":"NDC"}],"standard_charges":[{"gross_charge":23.98,"discounted_cash":23.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PROTONIX 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00008092355","type":"NDC"}],"standard_charges":[{"gross_charge":44.06,"discounted_cash":44.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050725","type":"NDC"}],"standard_charges":[{"gross_charge":59.97,"discounted_cash":59.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"63323028420","type":"NDC"}],"standard_charges":[{"gross_charge":34.02,"discounted_cash":34.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"63323050720","type":"NDC"}],"standard_charges":[{"gross_charge":45.98,"discounted_cash":45.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"44567010310","type":"NDC"}],"standard_charges":[{"gross_charge":61.46,"discounted_cash":61.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615604","type":"NDC"}],"standard_charges":[{"gross_charge":45.91,"discounted_cash":45.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00409653321","type":"NDC"}],"standard_charges":[{"gross_charge":25.94,"discounted_cash":25.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 UN"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70095002501","type":"NDC"}],"standard_charges":[{"gross_charge":67.81,"discounted_cash":67.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070125","type":"NDC"}],"standard_charges":[{"gross_charge":24.14,"discounted_cash":24.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"25021014330","type":"NDC"}],"standard_charges":[{"gross_charge":57.83,"discounted_cash":57.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00143985725","type":"NDC"}],"standard_charges":[{"gross_charge":30.18,"discounted_cash":30.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"67850015025","type":"NDC"}],"standard_charges":[{"gross_charge":35.05,"discounted_cash":35.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00781320895","type":"NDC"}],"standard_charges":[{"gross_charge":34.15,"discounted_cash":34.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"70436001982","type":"NDC"}],"standard_charges":[{"gross_charge":46.77,"discounted_cash":46.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00409139051","type":"NDC"}],"standard_charges":[{"gross_charge":37.84,"discounted_cash":37.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733201","type":"NDC"}],"standard_charges":[{"gross_charge":36.98,"discounted_cash":36.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"71288060011","type":"NDC"}],"standard_charges":[{"gross_charge":40.4,"discounted_cash":40.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039810","type":"NDC"}],"standard_charges":[{"gross_charge":46.22,"discounted_cash":46.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"25021010610","type":"NDC"}],"standard_charges":[{"gross_charge":43.67,"discounted_cash":43.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00781323295","type":"NDC"}],"standard_charges":[{"gross_charge":42.01,"discounted_cash":42.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"70095002403","type":"NDC"}],"standard_charges":[{"gross_charge":57.16,"discounted_cash":57.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615904","type":"NDC"}],"standard_charges":[{"gross_charge":67.88,"discounted_cash":67.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081430","type":"NDC"}],"standard_charges":[{"gross_charge":87.91,"discounted_cash":87.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"CEFTRIAXONE SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"44567070195","type":"NDC"}],"standard_charges":[{"gross_charge":33.57,"discounted_cash":33.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"UNASYN 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"00049001483","type":"NDC"}],"standard_charges":[{"gross_charge":74.38,"discounted_cash":74.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00409022210","type":"NDC"}],"standard_charges":[{"gross_charge":37.43,"discounted_cash":37.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"00781340895","type":"NDC"}],"standard_charges":[{"gross_charge":52.71,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"00781927395","type":"NDC"}],"standard_charges":[{"gross_charge":52.71,"discounted_cash":52.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"00781300095","type":"NDC"}],"standard_charges":[{"gross_charge":43.78,"discounted_cash":43.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"65219043620","type":"NDC"}],"standard_charges":[{"gross_charge":56.98,"discounted_cash":56.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"64679001201","type":"NDC"}],"standard_charges":[{"gross_charge":95.06,"discounted_cash":95.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CEFTRIAXONE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0696","type":"HCPCS"},{"code":"00409733801","type":"NDC"}],"standard_charges":[{"gross_charge":32.53,"discounted_cash":32.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 2.25 (2-0.25) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"55150011930","type":"NDC"}],"standard_charges":[{"gross_charge":52.67,"discounted_cash":52.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PROTONIX 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"00008400110","type":"NDC"}],"standard_charges":[{"gross_charge":41.48,"discounted_cash":41.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"CATHFLO ACTIVASE 2 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004110","type":"NDC"}],"standard_charges":[{"gross_charge":476.01,"discounted_cash":476.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"CATHFLO ACTIVASE 2 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2997","type":"HCPCS"},{"code":"50242004164","type":"NDC"}],"standard_charges":[{"gross_charge":476.04,"discounted_cash":476.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00338008904","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":79.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"LOVENOX 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801610","type":"NDC"}],"standard_charges":[{"gross_charge":28.12,"discounted_cash":28.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LOVENOX 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062280","type":"NDC"}],"standard_charges":[{"gross_charge":50.25,"discounted_cash":50.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"LOVENOX 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075801810","type":"NDC"}],"standard_charges":[{"gross_charge":27.56,"discounted_cash":27.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LOVENOX 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075802010","type":"NDC"}],"standard_charges":[{"gross_charge":28.38,"discounted_cash":28.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LOVENOX 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062300","type":"NDC"}],"standard_charges":[{"gross_charge":28.38,"discounted_cash":28.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"LOVENOX 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075802210","type":"NDC"}],"standard_charges":[{"gross_charge":72.57,"discounted_cash":72.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409475503","type":"NDC"}],"standard_charges":[{"gross_charge":17.31,"discounted_cash":17.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054741","type":"NDC"}],"standard_charges":[{"gross_charge":19.07,"discounted_cash":19.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"36000001225","type":"NDC"}],"standard_charges":[{"gross_charge":28.18,"discounted_cash":28.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054742","type":"NDC"}],"standard_charges":[{"gross_charge":20.27,"discounted_cash":20.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054842","type":"NDC"}],"standard_charges":[{"gross_charge":22.12,"discounted_cash":22.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"60505613005","type":"NDC"}],"standard_charges":[{"gross_charge":16.46,"discounted_cash":16.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"23155054841","type":"NDC"}],"standard_charges":[{"gross_charge":33.23,"discounted_cash":33.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00641607825","type":"NDC"}],"standard_charges":[{"gross_charge":28.55,"discounted_cash":28.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"55150012502","type":"NDC"}],"standard_charges":[{"gross_charge":31.2,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ONDANSETRON HCL 4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2405","type":"HCPCS"},{"code":"00409000925","type":"NDC"}],"standard_charges":[{"gross_charge":17.31,"discounted_cash":17.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LOVENOX 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00075062430","type":"NDC"}],"standard_charges":[{"gross_charge":46.62,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"XYLOCAINE-MPF 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049157","type":"NDC"}],"standard_charges":[{"gross_charge":43.25,"discounted_cash":43.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HALAVEN 1 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9179","type":"HCPCS"},{"code":"62856038901","type":"NDC"}],"standard_charges":[{"gross_charge":6056.1,"discounted_cash":6056.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.7 ML"}]},{"description":"XGEVA 120 MG/1.7ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513073001","type":"NDC"}],"standard_charges":[{"gross_charge":11472.55,"discounted_cash":11472.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.7 ML"}]},{"description":"FLUBLOK 0.5 ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"G0008","type":"HCPCS"},{"code":"49281072410","type":"NDC"}],"standard_charges":[{"gross_charge":352.38,"discounted_cash":352.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TEVIMBRA 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9329","type":"HCPCS"},{"code":"72579012101","type":"NDC"}],"standard_charges":[{"gross_charge":34867.32,"discounted_cash":34867.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"ORTHOVISC 30 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7324","type":"HCPCS"},{"code":"59676036001","type":"NDC"}],"standard_charges":[{"gross_charge":400.54,"discounted_cash":400.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HYALGAN 20 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89122072420","type":"NDC"}],"standard_charges":[{"gross_charge":610.43,"discounted_cash":610.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SUPARTZ FX 25 MG/2.5ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7321","type":"HCPCS"},{"code":"89130444401","type":"NDC"}],"standard_charges":[{"gross_charge":642.9,"discounted_cash":642.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"EUFLEXXA 20 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7323","type":"HCPCS"},{"code":"55566410001","type":"NDC"}],"standard_charges":[{"gross_charge":587.51,"discounted_cash":587.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GAMMAGARD 20 GM/200ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270006","type":"NDC"}],"standard_charges":[{"gross_charge":4040.43,"discounted_cash":4040.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"GAMMAGARD 30 GM/300ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270007","type":"NDC"}],"standard_charges":[{"gross_charge":4058.27,"discounted_cash":4058.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00264751010","type":"NDC"}],"standard_charges":[{"gross_charge":24.39,"discounted_cash":24.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"GAMMAGARD 5 GM/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270004","type":"NDC"}],"standard_charges":[{"gross_charge":2020.42,"discounted_cash":2020.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE-SODIUM CHLORIDE 5-0.9 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7042","type":"HCPCS"},{"code":"00264761000","type":"NDC"}],"standard_charges":[{"gross_charge":36.37,"discounted_cash":36.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ROPIVACAINE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"70069006425","type":"NDC"}],"standard_charges":[{"gross_charge":24.25,"discounted_cash":24.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"00409333024","type":"NDC"}],"standard_charges":[{"gross_charge":56.24,"discounted_cash":56.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409115902","type":"NDC"}],"standard_charges":[{"gross_charge":15.32,"discounted_cash":15.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264420452","type":"NDC"}],"standard_charges":[{"gross_charge":69.2,"discounted_cash":69.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 1-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00409234632","type":"NDC"}],"standard_charges":[{"gross_charge":92.27,"discounted_cash":92.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143933110","type":"NDC"}],"standard_charges":[{"gross_charge":20.32,"discounted_cash":20.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"VANCOMYCIN HCL IN NACL 2-0.9 GM/500ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70004092844","type":"NDC"}],"standard_charges":[{"gross_charge":382.21,"discounted_cash":382.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"36000028325","type":"NDC"}],"standard_charges":[{"gross_charge":15.6,"discounted_cash":15.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00143915610","type":"NDC"}],"standard_charges":[{"gross_charge":23.98,"discounted_cash":23.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792337","type":"NDC"}],"standard_charges":[{"gross_charge":49.57,"discounted_cash":49.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7070","type":"HCPCS"},{"code":"00990792255","type":"NDC"}],"standard_charges":[{"gross_charge":86.39,"discounted_cash":86.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"SODIUM CHLORIDE 3 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"00264780510","type":"NDC"}],"standard_charges":[{"gross_charge":25.59,"discounted_cash":25.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"DEXTROSE 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7060","type":"HCPCS"},{"code":"00264751020","type":"NDC"}],"standard_charges":[{"gross_charge":19.0,"discounted_cash":19.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"36000035240","type":"NDC"}],"standard_charges":[{"gross_charge":60.66,"discounted_cash":60.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"55150016330","type":"NDC"}],"standard_charges":[{"gross_charge":23.79,"discounted_cash":23.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 12 ML"}]},{"description":"MANNITOL 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2150","type":"HCPCS"},{"code":"00409403101","type":"NDC"}],"standard_charges":[{"gross_charge":55.73,"discounted_cash":55.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 150 ML"}]},{"description":"ACETAMINOPHEN 1000 MG/100 ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0131","type":"HCPCS"},{"code":"00781315695","type":"NDC"}],"standard_charges":[{"gross_charge":42.16,"discounted_cash":42.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010601","type":"NDC"}],"standard_charges":[{"gross_charge":54.39,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.5 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409116202","type":"NDC"}],"standard_charges":[{"gross_charge":13.8,"discounted_cash":13.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOPAMINE-DEXTROSE 1.6-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1265","type":"HCPCS"},{"code":"00338100702","type":"NDC"}],"standard_charges":[{"gross_charge":106.79,"discounted_cash":106.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"POTASSIUM CHLORIDE 20 MEQ/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990707526","type":"NDC"}],"standard_charges":[{"gross_charge":63.66,"discounted_cash":63.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVOFLOXACIN IN D5W 250 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"44567043524","type":"NDC"}],"standard_charges":[{"gross_charge":61.66,"discounted_cash":61.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVOFLOXACIN IN D5W 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1956","type":"HCPCS"},{"code":"25021013282","type":"NDC"}],"standard_charges":[{"gross_charge":61.66,"discounted_cash":61.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE 2 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323010605","type":"NDC"}],"standard_charges":[{"gross_charge":46.26,"discounted_cash":46.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"LINEZOLID 600 MG/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2020","type":"HCPCS"},{"code":"57664068357","type":"NDC"}],"standard_charges":[{"gross_charge":147.1,"discounted_cash":147.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"NITROGLYCERIN IN D5W 200-5 MCG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2305","type":"HCPCS"},{"code":"00338104902","type":"NDC"}],"standard_charges":[{"gross_charge":16.19,"discounted_cash":16.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"PROPOFOL 200 MG/20ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"23155034541","type":"NDC"}],"standard_charges":[{"gross_charge":16.24,"discounted_cash":16.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"43598054910","type":"NDC"}],"standard_charges":[{"gross_charge":117.32,"discounted_cash":117.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE IN D5W 900 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0737","type":"HCPCS"},{"code":"00338411424","type":"NDC"}],"standard_charges":[{"gross_charge":66.17,"discounted_cash":66.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"55150016710","type":"NDC"}],"standard_charges":[{"gross_charge":24.53,"discounted_cash":24.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ROPIVACAINE HCL 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"43066001510","type":"NDC"}],"standard_charges":[{"gross_charge":20.38,"discounted_cash":20.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.6 ML"}]},{"description":"EXPAREL 1.3 % IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9290","type":"HCPCS"},{"code":"65250026604","type":"NDC"}],"standard_charges":[{"gross_charge":457.24,"discounted_cash":457.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"GAMMAGARD 10 GM/100ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1569","type":"HCPCS"},{"code":"00944270005","type":"NDC"}],"standard_charges":[{"gross_charge":1416.49,"discounted_cash":1416.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 35 ML"}]},{"description":"GAMUNEX-C 20 GM/200ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080024","type":"NDC"}],"standard_charges":[{"gross_charge":1346.65,"discounted_cash":1346.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AZITHROMYCIN 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0456","type":"HCPCS"},{"code":"63323039814","type":"NDC"}],"standard_charges":[{"gross_charge":47.65,"discounted_cash":47.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594004602","type":"NDC"}],"standard_charges":[{"gross_charge":41.43,"discounted_cash":41.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 1 G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"70594012302","type":"NDC"}],"standard_charges":[{"gross_charge":41.48,"discounted_cash":41.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"60505615704","type":"NDC"}],"standard_charges":[{"gross_charge":52.9,"discounted_cash":52.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MEROPENEM 500 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2185","type":"HCPCS"},{"code":"55150020720","type":"NDC"}],"standard_charges":[{"gross_charge":44.09,"discounted_cash":44.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"AMPICILLIN SODIUM 2 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0290","type":"HCPCS"},{"code":"55150011420","type":"NDC"}],"standard_charges":[{"gross_charge":57.57,"discounted_cash":57.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"72485040401","type":"NDC"}],"standard_charges":[{"gross_charge":56.83,"discounted_cash":56.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 4.5 (4-0.5) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"81284015310","type":"NDC"}],"standard_charges":[{"gross_charge":56.78,"discounted_cash":56.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"DEFEROXAMINE MESYLATE 500 MG IJ SOLR (95 MG/ML WET VIAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"60505623606","type":"NDC"}],"standard_charges":[{"gross_charge":117.07,"discounted_cash":117.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"BORTEZOMIB 3.5 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9041","type":"HCPCS"},{"code":"43598042660","type":"NDC"}],"standard_charges":[{"gross_charge":128.84,"discounted_cash":128.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.343 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"23155031331","type":"NDC"}],"standard_charges":[{"gross_charge":49.05,"discounted_cash":49.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"CEFTAZIDIME 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0713","type":"HCPCS"},{"code":"25021012720","type":"NDC"}],"standard_charges":[{"gross_charge":72.05,"discounted_cash":72.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"55150020210","type":"NDC"}],"standard_charges":[{"gross_charge":50.67,"discounted_cash":50.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 100 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955401","type":"NDC"}],"standard_charges":[{"gross_charge":137.07,"discounted_cash":137.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"25021081530","type":"NDC"}],"standard_charges":[{"gross_charge":190.53,"discounted_cash":190.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"VANCOMYCIN HCL 750 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3370","type":"HCPCS"},{"code":"00409653102","type":"NDC"}],"standard_charges":[{"gross_charge":76.1,"discounted_cash":76.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"DEFEROXAMINE MESYLATE 500 MG IJ SOLR (95 MG/ML WET VIAL)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0895","type":"HCPCS"},{"code":"63323059710","type":"NDC"}],"standard_charges":[{"gross_charge":437.15,"discounted_cash":437.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022185","type":"NDC"}],"standard_charges":[{"gross_charge":48.53,"discounted_cash":48.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"42023022110","type":"NDC"}],"standard_charges":[{"gross_charge":48.53,"discounted_cash":48.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"00143955201","type":"NDC"}],"standard_charges":[{"gross_charge":109.88,"discounted_cash":109.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.166 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"63323071050","type":"NDC"}],"standard_charges":[{"gross_charge":406.33,"discounted_cash":406.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"MITOMYCIN 20 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9280","type":"HCPCS"},{"code":"71288013850","type":"NDC"}],"standard_charges":[{"gross_charge":1180.75,"discounted_cash":1180.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.85 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"00409351022","type":"NDC"}],"standard_charges":[{"gross_charge":90.84,"discounted_cash":90.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 UN"}]},{"description":"ERTAPENEM SODIUM 1 G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1335","type":"HCPCS"},{"code":"72266015910","type":"NDC"}],"standard_charges":[{"gross_charge":168.71,"discounted_cash":168.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016450","type":"NDC"}],"standard_charges":[{"gross_charge":593.9,"discounted_cash":593.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"ACETAZOLAMIDE SODIUM 500 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1120","type":"HCPCS"},{"code":"00143950301","type":"NDC"}],"standard_charges":[{"gross_charge":154.99,"discounted_cash":154.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"LEUCOVORIN CALCIUM 350 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"71288016330","type":"NDC"}],"standard_charges":[{"gross_charge":109.26,"discounted_cash":109.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.16 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"43598046562","type":"NDC"}],"standard_charges":[{"gross_charge":167.02,"discounted_cash":167.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 UN"}]},{"description":"AZACITIDINE 100 MG IJ SUSR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9025","type":"HCPCS"},{"code":"00143960601","type":"NDC"}],"standard_charges":[{"gross_charge":434.08,"discounted_cash":434.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 UN"}]},{"description":"LEUCOVORIN CALCIUM 200 MG IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0640","type":"HCPCS"},{"code":"67457052920","type":"NDC"}],"standard_charges":[{"gross_charge":342.64,"discounted_cash":342.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"GAMUNEX-C 5 GM/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080020","type":"NDC"}],"standard_charges":[{"gross_charge":1370.49,"discounted_cash":1370.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"64679005601","type":"NDC"}],"standard_charges":[{"gross_charge":61.37,"discounted_cash":61.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PANTOPRAZOLE SODIUM 40 MG IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2470","type":"HCPCS"},{"code":"70095002402","type":"NDC"}],"standard_charges":[{"gross_charge":65.2,"discounted_cash":65.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 UN"}]},{"description":"GAMUNEX-C 10 GM/100ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080071","type":"NDC"}],"standard_charges":[{"gross_charge":1326.09,"discounted_cash":1326.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"GAMUNEX-C 40 GM/400ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"13533080040","type":"NDC"}],"standard_charges":[{"gross_charge":9748.32,"discounted_cash":9748.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 350 ML"}]},{"description":"GAMMAKED 20 GM/200ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"76125090020","type":"NDC"}],"standard_charges":[{"gross_charge":7512.99,"discounted_cash":7512.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"GAMMAKED 10 GM/100ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"76125090010","type":"NDC"}],"standard_charges":[{"gross_charge":3451.85,"discounted_cash":3451.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"GAMMAKED 5 GM/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1561","type":"HCPCS"},{"code":"76125090050","type":"NDC"}],"standard_charges":[{"gross_charge":1732.31,"discounted_cash":1732.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"OCTAGAM 30 GM/300ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1568","type":"HCPCS"},{"code":"68982085005","type":"NDC"}],"standard_charges":[{"gross_charge":10373.31,"discounted_cash":10373.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 300 ML"}]},{"description":"XYLOCAINE-MPF 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049231","type":"NDC"}],"standard_charges":[{"gross_charge":42.52,"discounted_cash":42.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"XYLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323049507","type":"NDC"}],"standard_charges":[{"gross_charge":15.5,"discounted_cash":15.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"POLOCAINE-MPF 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0670","type":"HCPCS"},{"code":"63323029427","type":"NDC"}],"standard_charges":[{"gross_charge":13.31,"discounted_cash":13.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"SENSORCAINE-MPF 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323046438","type":"NDC"}],"standard_charges":[{"gross_charge":15.28,"discounted_cash":15.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN (PORCINE) IN NACL 25000-0.45 UT/250ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409765062","type":"NDC"}],"standard_charges":[{"gross_charge":91.02,"discounted_cash":91.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"VANCOMYCIN HCL 1250 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3372","type":"HCPCS"},{"code":"70594005702","type":"NDC"}],"standard_charges":[{"gross_charge":125.17,"discounted_cash":125.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"MAGNESIUM SULFATE 4 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"67457055400","type":"NDC"}],"standard_charges":[{"gross_charge":72.69,"discounted_cash":72.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 500 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"44567050110","type":"NDC"}],"standard_charges":[{"gross_charge":72.69,"discounted_cash":72.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MILRINONE LACTATE IN DEXTROSE 20-5 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2260","type":"HCPCS"},{"code":"00143971910","type":"NDC"}],"standard_charges":[{"gross_charge":89.08,"discounted_cash":89.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LEVETIRACETAM IN NACL 1000 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"14789022010","type":"NDC"}],"standard_charges":[{"gross_charge":87.74,"discounted_cash":87.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DOBUTAMINE-DEXTROSE 2-5 MG/ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1250","type":"HCPCS"},{"code":"00409234732","type":"NDC"}],"standard_charges":[{"gross_charge":123.13,"discounted_cash":123.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"FENTANYL CITRATE (PF) 2500 MCG/50ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080650","type":"NDC"}],"standard_charges":[{"gross_charge":60.42,"discounted_cash":60.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"BUPIVACAINE HCL (PF) 0.25 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00143933010","type":"NDC"}],"standard_charges":[{"gross_charge":22.49,"discounted_cash":22.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PROPOFOL 1000 MG/100ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2704","type":"HCPCS"},{"code":"00069024810","type":"NDC"}],"standard_charges":[{"gross_charge":14.65,"discounted_cash":14.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.04 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"63323028004","type":"NDC"}],"standard_charges":[{"gross_charge":15.74,"discounted_cash":15.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068852","type":"NDC"}],"standard_charges":[{"gross_charge":152.13,"discounted_cash":152.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"CALCIUM GLUCONATE-NACL 2-0.675 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"44567062124","type":"NDC"}],"standard_charges":[{"gross_charge":134.16,"discounted_cash":134.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"LACTATED RINGERS IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7120","type":"HCPCS"},{"code":"00264775010","type":"NDC"}],"standard_charges":[{"gross_charge":16.0,"discounted_cash":16.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SODIUM CHLORIDE 3 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7131","type":"HCPCS"},{"code":"63323053075","type":"NDC"}],"standard_charges":[{"gross_charge":61.31,"discounted_cash":61.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"DEXTROSE IN LACTATED RINGERS 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7121","type":"HCPCS"},{"code":"00264775100","type":"NDC"}],"standard_charges":[{"gross_charge":41.75,"discounted_cash":41.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"CIPROFLOXACIN IN D5W 400 MG/200ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0744","type":"HCPCS"},{"code":"00409330024","type":"NDC"}],"standard_charges":[{"gross_charge":44.8,"discounted_cash":44.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MAGNESIUM SULFATE IN D5W 1-5 GM/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"00264440054","type":"NDC"}],"standard_charges":[{"gross_charge":63.65,"discounted_cash":63.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"AMPICILLIN-SULBACTAM SODIUM 3 (2-1) G IJ SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0295","type":"HCPCS"},{"code":"55150011710","type":"NDC"}],"standard_charges":[{"gross_charge":64.59,"discounted_cash":64.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PIPERACILLIN SOD-TAZOBACTAM SO 3.375 (3-0.375) G IV SOLR","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"68001050782","type":"NDC"}],"standard_charges":[{"gross_charge":62.26,"discounted_cash":62.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 UN"}]},{"description":"PNEUMOVAX 23 25 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90732","type":"HCPCS"},{"code":"00006483703","type":"NDC"}],"standard_charges":[{"gross_charge":381.63,"discounted_cash":381.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TENIVAC 5-2 LFU IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021515","type":"NDC"}],"standard_charges":[{"gross_charge":204.62,"discounted_cash":204.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TENIVAC 5-2 LFU IM INJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90714","type":"HCPCS"},{"code":"49281021510","type":"NDC"}],"standard_charges":[{"gross_charge":204.62,"discounted_cash":204.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"55150031925","type":"NDC"}],"standard_charges":[{"gross_charge":82.26,"discounted_cash":82.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"69918089910","type":"NDC"}],"standard_charges":[{"gross_charge":89.22,"discounted_cash":89.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.723 ML"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55111067802","type":"NDC"}],"standard_charges":[{"gross_charge":67.93,"discounted_cash":67.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DESMOPRESSIN ACETATE 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"39822620002","type":"NDC"}],"standard_charges":[{"gross_charge":56.23,"discounted_cash":56.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"00517198005","type":"NDC"}],"standard_charges":[{"gross_charge":52.34,"discounted_cash":52.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023320","type":"NDC"}],"standard_charges":[{"gross_charge":317.72,"discounted_cash":317.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.5 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"14789001002","type":"NDC"}],"standard_charges":[{"gross_charge":78.29,"discounted_cash":78.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 5000 UNIT/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71839011825","type":"NDC"}],"standard_charges":[{"gross_charge":38.14,"discounted_cash":38.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"70436014781","type":"NDC"}],"standard_charges":[{"gross_charge":57.32,"discounted_cash":57.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041076","type":"NDC"}],"standard_charges":[{"gross_charge":45.65,"discounted_cash":45.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329346901","type":"NDC"}],"standard_charges":[{"gross_charge":79.93,"discounted_cash":79.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"00143902202","type":"NDC"}],"standard_charges":[{"gross_charge":430.41,"discounted_cash":430.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"SUMATRIPTAN SUCCINATE 6 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3030","type":"HCPCS"},{"code":"55150017305","type":"NDC"}],"standard_charges":[{"gross_charge":52.04,"discounted_cash":52.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560300","type":"NDC"}],"standard_charges":[{"gross_charge":71.69,"discounted_cash":71.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"DEXAMETHASONE SODIUM PHOSPHATE 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"67457042312","type":"NDC"}],"standard_charges":[{"gross_charge":20.62,"discounted_cash":20.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ATROPINE SULFATE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"16729052508","type":"NDC"}],"standard_charges":[{"gross_charge":43.32,"discounted_cash":43.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ATROPINE SULFATE 0.4 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00517100425","type":"NDC"}],"standard_charges":[{"gross_charge":38.68,"discounted_cash":38.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ATROPINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00517100125","type":"NDC"}],"standard_charges":[{"gross_charge":50.6,"discounted_cash":50.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ULTOMIRIS 300 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1303","type":"HCPCS"},{"code":"25682002501","type":"NDC"}],"standard_charges":[{"gross_charge":21885.27,"discounted_cash":21885.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"HYDROMORPHONE HCL PF 50 MG/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"00703011303","type":"NDC"}],"standard_charges":[{"gross_charge":49.46,"discounted_cash":49.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MORPHINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612725","type":"NDC"}],"standard_charges":[{"gross_charge":17.24,"discounted_cash":17.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"PERJETA 420 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9306","type":"HCPCS"},{"code":"50242014501","type":"NDC"}],"standard_charges":[{"gross_charge":21773.39,"discounted_cash":21773.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 ML"}]},{"description":"DUROLANE 60 MG/3ML IX PRSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7318","type":"HCPCS"},{"code":"89130202001","type":"NDC"}],"standard_charges":[{"gross_charge":1770.58,"discounted_cash":1770.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"CINVANTI 130 MG/18ML IV EMUL","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0185","type":"HCPCS"},{"code":"47426020101","type":"NDC"}],"standard_charges":[{"gross_charge":762.95,"discounted_cash":762.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 18 ML"}]},{"description":"FASENRA 30 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0517","type":"HCPCS"},{"code":"00310173030","type":"NDC"}],"standard_charges":[{"gross_charge":16671.87,"discounted_cash":16671.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SUBLOCADE 100 MG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9991","type":"HCPCS"},{"code":"12496010001","type":"NDC"}],"standard_charges":[{"gross_charge":4288.86,"discounted_cash":4288.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"OPDIVO 240 MG/24ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9299","type":"HCPCS"},{"code":"00003373413","type":"NDC"}],"standard_charges":[{"gross_charge":3269.02,"discounted_cash":3269.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"KEDRAB 300 UNIT/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125015002","type":"NDC"}],"standard_charges":[{"gross_charge":726.03,"discounted_cash":726.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DILAUDID 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1170","type":"HCPCS"},{"code":"76045000911","type":"NDC"}],"standard_charges":[{"gross_charge":23.56,"discounted_cash":23.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046142","type":"NDC"}],"standard_charges":[{"gross_charge":32.3,"discounted_cash":32.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"BUTORPHANOL TARTRATE 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0595","type":"HCPCS"},{"code":"00409162601","type":"NDC"}],"standard_charges":[{"gross_charge":39.09,"discounted_cash":39.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043292","type":"NDC"}],"standard_charges":[{"gross_charge":37.33,"discounted_cash":37.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"55150019183","type":"NDC"}],"standard_charges":[{"gross_charge":468.27,"discounted_cash":468.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9046","type":"HCPCS"},{"code":"81665030102","type":"NDC"}],"standard_charges":[{"gross_charge":795.23,"discounted_cash":795.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"71288055586","type":"NDC"}],"standard_charges":[{"gross_charge":6475.28,"discounted_cash":6475.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"54288013710","type":"NDC"}],"standard_charges":[{"gross_charge":240.38,"discounted_cash":240.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"00548970100","type":"NDC"}],"standard_charges":[{"gross_charge":277.95,"discounted_cash":277.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714004610","type":"NDC"}],"standard_charges":[{"gross_charge":111.27,"discounted_cash":111.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9394","type":"HCPCS"},{"code":"63323071505","type":"NDC"}],"standard_charges":[{"gross_charge":1324.34,"discounted_cash":1324.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153101","type":"NDC"}],"standard_charges":[{"gross_charge":6892.63,"discounted_cash":6892.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"70121148001","type":"NDC"}],"standard_charges":[{"gross_charge":344.53,"discounted_cash":344.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"70710153001","type":"NDC"}],"standard_charges":[{"gross_charge":3439.28,"discounted_cash":3439.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"43598093109","type":"NDC"}],"standard_charges":[{"gross_charge":395.42,"discounted_cash":395.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.7 ML"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560600","type":"NDC"}],"standard_charges":[{"gross_charge":97.82,"discounted_cash":97.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955101210","type":"NDC"}],"standard_charges":[{"gross_charge":72.57,"discounted_cash":72.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"43598026223","type":"NDC"}],"standard_charges":[{"gross_charge":1214.47,"discounted_cash":1214.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FONDAPARINUX SODIUM 2.5 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1652","type":"HCPCS"},{"code":"55150023010","type":"NDC"}],"standard_charges":[{"gross_charge":46.73,"discounted_cash":46.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"96372","type":"HCPCS"},{"code":"00409656201","type":"NDC"}],"standard_charges":[{"gross_charge":62.44,"discounted_cash":62.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560400","type":"NDC"}],"standard_charges":[{"gross_charge":36.63,"discounted_cash":36.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560500","type":"NDC"}],"standard_charges":[{"gross_charge":36.63,"discounted_cash":36.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"CHLORPROMAZINE HCL 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"00641139835","type":"NDC"}],"standard_charges":[{"gross_charge":139.86,"discounted_cash":139.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HYDROXYZINE HCL 50 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"00517560125","type":"NDC"}],"standard_charges":[{"gross_charge":115.87,"discounted_cash":115.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"69097070896","type":"NDC"}],"standard_charges":[{"gross_charge":78.78,"discounted_cash":78.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FOMEPIZOLE 1.5 GM/1.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1451","type":"HCPCS"},{"code":"70710147801","type":"NDC"}],"standard_charges":[{"gross_charge":1270.72,"discounted_cash":1270.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.4 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00409198530","type":"NDC"}],"standard_charges":[{"gross_charge":21.51,"discounted_cash":21.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 5000 UNIT/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323054313","type":"NDC"}],"standard_charges":[{"gross_charge":41.35,"discounted_cash":41.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329336901","type":"NDC"}],"standard_charges":[{"gross_charge":33.05,"discounted_cash":33.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457039054","type":"NDC"}],"standard_charges":[{"gross_charge":149.69,"discounted_cash":149.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.125 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"00641623125","type":"NDC"}],"standard_charges":[{"gross_charge":36.78,"discounted_cash":36.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011310","type":"NDC"}],"standard_charges":[{"gross_charge":51.02,"discounted_cash":51.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"68001035525","type":"NDC"}],"standard_charges":[{"gross_charge":202.21,"discounted_cash":202.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KEDRAB 1500 UNIT/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90377","type":"HCPCS"},{"code":"76125015010","type":"NDC"}],"standard_charges":[{"gross_charge":8739.95,"discounted_cash":8739.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"HYPERRAB 1500 UNIT/5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90375","type":"HCPCS"},{"code":"13533031805","type":"NDC"}],"standard_charges":[{"gross_charge":8745.71,"discounted_cash":8745.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.9 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323068310","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"IBUTILIDE FUMARATE 1 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1742","type":"HCPCS"},{"code":"67457036610","type":"NDC"}],"standard_charges":[{"gross_charge":416.71,"discounted_cash":416.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00517970225","type":"NDC"}],"standard_charges":[{"gross_charge":23.46,"discounted_cash":23.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"63323084202","type":"NDC"}],"standard_charges":[{"gross_charge":57.17,"discounted_cash":57.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL PF 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409263401","type":"NDC"}],"standard_charges":[{"gross_charge":194.31,"discounted_cash":194.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189323","type":"NDC"}],"standard_charges":[{"gross_charge":42.63,"discounted_cash":42.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"54288010001","type":"NDC"}],"standard_charges":[{"gross_charge":49.54,"discounted_cash":49.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041071","type":"NDC"}],"standard_charges":[{"gross_charge":25.4,"discounted_cash":25.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043689","type":"NDC"}],"standard_charges":[{"gross_charge":31.39,"discounted_cash":31.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011110","type":"NDC"}],"standard_charges":[{"gross_charge":50.45,"discounted_cash":50.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"25021023310","type":"NDC"}],"standard_charges":[{"gross_charge":209.17,"discounted_cash":209.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955101010","type":"NDC"}],"standard_charges":[{"gross_charge":28.38,"discounted_cash":28.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 100 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781326869","type":"NDC"}],"standard_charges":[{"gross_charge":28.27,"discounted_cash":28.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"16714007002","type":"NDC"}],"standard_charges":[{"gross_charge":872.81,"discounted_cash":872.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"69339013634","type":"NDC"}],"standard_charges":[{"gross_charge":36.25,"discounted_cash":36.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001045942","type":"NDC"}],"standard_charges":[{"gross_charge":31.36,"discounted_cash":31.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"63323014010","type":"NDC"}],"standard_charges":[{"gross_charge":416.3,"discounted_cash":416.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.2 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"16714013025","type":"NDC"}],"standard_charges":[{"gross_charge":38.03,"discounted_cash":38.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"36000036401","type":"NDC"}],"standard_charges":[{"gross_charge":202.99,"discounted_cash":202.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00409121501","type":"NDC"}],"standard_charges":[{"gross_charge":47.33,"discounted_cash":47.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"00517090125","type":"NDC"}],"standard_charges":[{"gross_charge":41.42,"discounted_cash":41.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.15 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1030","type":"HCPCS"},{"code":"60219157305","type":"NDC"}],"standard_charges":[{"gross_charge":59.17,"discounted_cash":59.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"70121148307","type":"NDC"}],"standard_charges":[{"gross_charge":424.41,"discounted_cash":424.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9.4 ML"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"76329146901","type":"NDC"}],"standard_charges":[{"gross_charge":79.8,"discounted_cash":79.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 5000 UNIT/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409131632","type":"NDC"}],"standard_charges":[{"gross_charge":39.12,"discounted_cash":39.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00143951425","type":"NDC"}],"standard_charges":[{"gross_charge":31.61,"discounted_cash":31.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"00641624410","type":"NDC"}],"standard_charges":[{"gross_charge":36.4,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955100810","type":"NDC"}],"standard_charges":[{"gross_charge":27.56,"discounted_cash":27.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"00641617310","type":"NDC"}],"standard_charges":[{"gross_charge":67.33,"discounted_cash":67.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ARSENIC TRIOXIDE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9017","type":"HCPCS"},{"code":"25021022610","type":"NDC"}],"standard_charges":[{"gross_charge":849.19,"discounted_cash":849.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 9.4 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00143965901","type":"NDC"}],"standard_charges":[{"gross_charge":58.83,"discounted_cash":58.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157305","type":"NDC"}],"standard_charges":[{"gross_charge":59.44,"discounted_cash":59.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"CLADRIBINE 10 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9065","type":"HCPCS"},{"code":"00143987101","type":"NDC"}],"standard_charges":[{"gross_charge":2617.69,"discounted_cash":2617.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7.5 ML"}]},{"description":"IRINOTECAN HCL 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"55150035401","type":"NDC"}],"standard_charges":[{"gross_charge":92.33,"discounted_cash":92.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"76045010410","type":"NDC"}],"standard_charges":[{"gross_charge":39.72,"discounted_cash":39.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70121146302","type":"NDC"}],"standard_charges":[{"gross_charge":878.97,"discounted_cash":878.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781323863","type":"NDC"}],"standard_charges":[{"gross_charge":47.15,"discounted_cash":47.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"00409127332","type":"NDC"}],"standard_charges":[{"gross_charge":33.5,"discounted_cash":33.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"63323093001","type":"NDC"}],"standard_charges":[{"gross_charge":113.62,"discounted_cash":113.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"72266012705","type":"NDC"}],"standard_charges":[{"gross_charge":96.48,"discounted_cash":96.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CHLORPROMAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3230","type":"HCPCS"},{"code":"00641139735","type":"NDC"}],"standard_charges":[{"gross_charge":124.81,"discounted_cash":124.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781325666","type":"NDC"}],"standard_charges":[{"gross_charge":76.08,"discounted_cash":76.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"60505611600","type":"NDC"}],"standard_charges":[{"gross_charge":416.09,"discounted_cash":416.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"66993037179","type":"NDC"}],"standard_charges":[{"gross_charge":176.42,"discounted_cash":176.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"70121146702","type":"NDC"}],"standard_charges":[{"gross_charge":151.46,"discounted_cash":151.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121104902","type":"NDC"}],"standard_charges":[{"gross_charge":14.72,"discounted_cash":14.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022905","type":"NDC"}],"standard_charges":[{"gross_charge":35.46,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"00409233934","type":"NDC"}],"standard_charges":[{"gross_charge":34.88,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085404","type":"NDC"}],"standard_charges":[{"gross_charge":78.34,"discounted_cash":78.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"67457085502","type":"NDC"}],"standard_charges":[{"gross_charge":33.34,"discounted_cash":33.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.33 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"00703409401","type":"NDC"}],"standard_charges":[{"gross_charge":75.75,"discounted_cash":75.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDROMORPHONE HCL 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00641625910","type":"NDC"}],"standard_charges":[{"gross_charge":59.5,"discounted_cash":59.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00703024101","type":"NDC"}],"standard_charges":[{"gross_charge":48.27,"discounted_cash":48.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NALOXONE HCL 2 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"00641620510","type":"NDC"}],"standard_charges":[{"gross_charge":51.96,"discounted_cash":51.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043587","type":"NDC"}],"standard_charges":[{"gross_charge":24.91,"discounted_cash":24.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"00703398501","type":"NDC"}],"standard_charges":[{"gross_charge":84.68,"discounted_cash":84.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1030","type":"HCPCS"},{"code":"70121157301","type":"NDC"}],"standard_charges":[{"gross_charge":41.72,"discounted_cash":41.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"25021047174","type":"NDC"}],"standard_charges":[{"gross_charge":1248.38,"discounted_cash":1248.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046042","type":"NDC"}],"standard_charges":[{"gross_charge":33.96,"discounted_cash":33.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"PAPAVERINE HCL 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2440","type":"HCPCS"},{"code":"54288014210","type":"NDC"}],"standard_charges":[{"gross_charge":87.52,"discounted_cash":87.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041070","type":"NDC"}],"standard_charges":[{"gross_charge":46.04,"discounted_cash":46.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"IRINOTECAN HCL 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"60505612801","type":"NDC"}],"standard_charges":[{"gross_charge":58.72,"discounted_cash":58.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"00641618225","type":"NDC"}],"standard_charges":[{"gross_charge":45.72,"discounted_cash":45.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROMETHAZINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641149635","type":"NDC"}],"standard_charges":[{"gross_charge":38.69,"discounted_cash":38.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323027602","type":"NDC"}],"standard_charges":[{"gross_charge":47.35,"discounted_cash":47.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"68001034536","type":"NDC"}],"standard_charges":[{"gross_charge":2869.12,"discounted_cash":2869.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"HYOSCYAMINE SULFATE 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1980","type":"HCPCS"},{"code":"54288011105","type":"NDC"}],"standard_charges":[{"gross_charge":410.38,"discounted_cash":410.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROXYZINE HCL 25 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3410","type":"HCPCS"},{"code":"00517420125","type":"NDC"}],"standard_charges":[{"gross_charge":101.67,"discounted_cash":101.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NEXTERONE 360-4.14 MG/200ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066036020","type":"NDC"}],"standard_charges":[{"gross_charge":293.05,"discounted_cash":293.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ALBUKED 25 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"76125079225","type":"NDC"}],"standard_charges":[{"gross_charge":241.46,"discounted_cash":241.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ALBUKED 25 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"76125079210","type":"NDC"}],"standard_charges":[{"gross_charge":328.78,"discounted_cash":328.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68516521609","type":"NDC"}],"standard_charges":[{"gross_charge":258.16,"discounted_cash":258.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68516521602","type":"NDC"}],"standard_charges":[{"gross_charge":263.97,"discounted_cash":263.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"KEDBUMIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"76179002504","type":"NDC"}],"standard_charges":[{"gross_charge":776.81,"discounted_cash":776.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 200 ML"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68516521600","type":"NDC"}],"standard_charges":[{"gross_charge":258.89,"discounted_cash":258.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ALBUTEIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9047","type":"HCPCS"},{"code":"68516521601","type":"NDC"}],"standard_charges":[{"gross_charge":266.15,"discounted_cash":266.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"SPEVIGO 450 MG/7.5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1747","type":"HCPCS"},{"code":"00597003510","type":"NDC"}],"standard_charges":[{"gross_charge":178150.09,"discounted_cash":178150.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"FLEXBUMIN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"00944049302","type":"NDC"}],"standard_charges":[{"gross_charge":438.56,"discounted_cash":438.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ELAHERE 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9063","type":"HCPCS"},{"code":"72903085301","type":"NDC"}],"standard_charges":[{"gross_charge":2217.99,"discounted_cash":2217.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"IMJUDO 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9347","type":"HCPCS"},{"code":"00310453530","type":"NDC"}],"standard_charges":[{"gross_charge":129377.96,"discounted_cash":129377.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"VEGZELMA 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001101","type":"NDC"}],"standard_charges":[{"gross_charge":3432.1,"discounted_cash":3432.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"VEGZELMA 400 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5129","type":"HCPCS"},{"code":"72606001201","type":"NDC"}],"standard_charges":[{"gross_charge":9996.77,"discounted_cash":9996.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"TEZSPIRE 210 MG/1.91ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2356","type":"HCPCS"},{"code":"55513012301","type":"NDC"}],"standard_charges":[{"gross_charge":15980.46,"discounted_cash":15980.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.91 ML"}]},{"description":"DUPIXENT 300 MG/2ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9399","type":"HCPCS"},{"code":"00024591401","type":"NDC"}],"standard_charges":[{"gross_charge":5972.6,"discounted_cash":5972.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"OCREVUS 300 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2350","type":"HCPCS"},{"code":"50242015001","type":"NDC"}],"standard_charges":[{"gross_charge":141010.87,"discounted_cash":141010.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"IMFINZI 500 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9173","type":"HCPCS"},{"code":"00310461150","type":"NDC"}],"standard_charges":[{"gross_charge":40297.3,"discounted_cash":40297.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"RITUXAN HYCELA 1400-23400 MG -UT/11.7ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9311","type":"HCPCS"},{"code":"50242010801","type":"NDC"}],"standard_charges":[{"gross_charge":16621.24,"discounted_cash":16621.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.7 ML"}]},{"description":"CLEOCIN PHOSPHATE 600 MG/4ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009077526","type":"NDC"}],"standard_charges":[{"gross_charge":39.19,"discounted_cash":39.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CLEOCIN PHOSPHATE 900 MG/6ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009090218","type":"NDC"}],"standard_charges":[{"gross_charge":33.89,"discounted_cash":33.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.667 ML"}]},{"description":"CLEOCIN PHOSPHATE 300 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"00009087026","type":"NDC"}],"standard_charges":[{"gross_charge":60.73,"discounted_cash":60.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"SOMATULINE DEPOT 120 MG/0.5ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1930","type":"HCPCS"},{"code":"15054112004","type":"NDC"}],"standard_charges":[{"gross_charge":18631.75,"discounted_cash":18631.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CEREBYX 500 MG PE/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2009","type":"HCPCS"},{"code":"00069600121","type":"NDC"}],"standard_charges":[{"gross_charge":110.69,"discounted_cash":110.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"BICILLIN L-A 1200000 UNIT/2ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070110","type":"NDC"}],"standard_charges":[{"gross_charge":1070.32,"discounted_cash":1070.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BICILLIN L-A 2400000 UNIT/4ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0561","type":"HCPCS"},{"code":"60793070210","type":"NDC"}],"standard_charges":[{"gross_charge":2127.74,"discounted_cash":2127.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"VECTIBIX 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095401","type":"NDC"}],"standard_charges":[{"gross_charge":10730.33,"discounted_cash":10730.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ACTEMRA 80 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013501","type":"NDC"}],"standard_charges":[{"gross_charge":344.89,"discounted_cash":344.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ACTEMRA 200 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":344.89,"discounted_cash":344.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"NEXTERONE 150-4.21 MG/100ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0283","type":"HCPCS"},{"code":"43066015010","type":"NDC"}],"standard_charges":[{"gross_charge":217.56,"discounted_cash":217.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ACTEMRA 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013701","type":"NDC"}],"standard_charges":[{"gross_charge":2880.07,"discounted_cash":2880.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 6.5 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.45 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338070434","type":"NDC"}],"standard_charges":[{"gross_charge":120.01,"discounted_cash":120.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"ZOSYN 3-0.375 GM/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2543","type":"HCPCS"},{"code":"00338963624","type":"NDC"}],"standard_charges":[{"gross_charge":114.32,"discounted_cash":114.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"AMPHADASE 150 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3470","type":"HCPCS"},{"code":"00548909010","type":"NDC"}],"standard_charges":[{"gross_charge":92.34,"discounted_cash":92.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"VAQTA 50 UNIT/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90632","type":"HCPCS"},{"code":"00006409602","type":"NDC"}],"standard_charges":[{"gross_charge":172.51,"discounted_cash":172.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091011","type":"NDC"}],"standard_charges":[{"gross_charge":499.38,"discounted_cash":499.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GRANIX 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091211","type":"NDC"}],"standard_charges":[{"gross_charge":767.1,"discounted_cash":767.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"GRANIX 480 MCG/0.8ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091217","type":"NDC"}],"standard_charges":[{"gross_charge":1421.8,"discounted_cash":1421.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"GAZYVA 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":3728.48,"discounted_cash":3728.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"MONOVISC 88 MG/4ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7327","type":"HCPCS"},{"code":"59676082001","type":"NDC"}],"standard_charges":[{"gross_charge":2010.58,"discounted_cash":2010.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CYRAMZA 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"00002766901","type":"NDC"}],"standard_charges":[{"gross_charge":2035.39,"discounted_cash":2035.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CYRAMZA 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9308","type":"HCPCS"},{"code":"00002767801","type":"NDC"}],"standard_charges":[{"gross_charge":23483.11,"discounted_cash":23483.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"ADACEL 5-2-15.5 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"49281040010","type":"NDC"}],"standard_charges":[{"gross_charge":246.98,"discounted_cash":246.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SOLIRIS 300 MG/30ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1300","type":"HCPCS"},{"code":"25682000101","type":"NDC"}],"standard_charges":[{"gross_charge":66850.33,"discounted_cash":66850.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 90 ML"}]},{"description":"RUXIENCE 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069023801","type":"NDC"}],"standard_charges":[{"gross_charge":1255.7,"discounted_cash":1255.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"RUXIENCE 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5119","type":"HCPCS"},{"code":"00069024901","type":"NDC"}],"standard_charges":[{"gross_charge":8773.17,"discounted_cash":8773.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"VYEPTI 100 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3032","type":"HCPCS"},{"code":"67386013051","type":"NDC"}],"standard_charges":[{"gross_charge":6461.39,"discounted_cash":6461.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SYNVISC 16 MG/2ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468009001","type":"NDC"}],"standard_charges":[{"gross_charge":770.81,"discounted_cash":770.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"SYNVISC ONE 48 MG/6ML IX SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J7325","type":"HCPCS"},{"code":"58468009003","type":"NDC"}],"standard_charges":[{"gross_charge":423.93,"discounted_cash":423.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091017","type":"NDC"}],"standard_charges":[{"gross_charge":897.47,"discounted_cash":897.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GRANIX 300 MCG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1447","type":"HCPCS"},{"code":"63459091036","type":"NDC"}],"standard_charges":[{"gross_charge":897.44,"discounted_cash":897.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ERBITUX 100 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733094823","type":"NDC"}],"standard_charges":[{"gross_charge":2010.42,"discounted_cash":2010.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"TYSABRI 300 MG/15ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2323","type":"HCPCS"},{"code":"64406000801","type":"NDC"}],"standard_charges":[{"gross_charge":27115.08,"discounted_cash":27115.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"ADACEL 5-2-15.5 LF-MCG/0.5 IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90715","type":"HCPCS"},{"code":"49281040020","type":"NDC"}],"standard_charges":[{"gross_charge":246.98,"discounted_cash":246.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SARCLISA 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"00024065401","type":"NDC"}],"standard_charges":[{"gross_charge":4237.02,"discounted_cash":4237.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"FERAHEME 510 MG/17ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"59338077501","type":"NDC"}],"standard_charges":[{"gross_charge":1934.11,"discounted_cash":1934.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 ML"}]},{"description":"SARCLISA 500 MG/25ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9227","type":"HCPCS"},{"code":"00024065601","type":"NDC"}],"standard_charges":[{"gross_charge":12038.82,"discounted_cash":12038.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"DARZALEX FASPRO 1800-30000 MG-UT/15ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9144","type":"HCPCS"},{"code":"57894050301","type":"NDC"}],"standard_charges":[{"gross_charge":33732.08,"discounted_cash":33732.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"NYVEPRIA 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5122","type":"HCPCS"},{"code":"00069032401","type":"NDC"}],"standard_charges":[{"gross_charge":5685.58,"discounted_cash":5685.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"PHESGO 60-60-2000 MG-MG-U/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242026001","type":"NDC"}],"standard_charges":[{"gross_charge":30334.63,"discounted_cash":30334.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PHESGO 80-40-2000 MG-MG-U/ML SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9316","type":"HCPCS"},{"code":"50242024501","type":"NDC"}],"standard_charges":[{"gross_charge":41719.34,"discounted_cash":41719.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 15 ML"}]},{"description":"KESIMPTA 20 MG/0.4ML SC SOAJ","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9302","type":"HCPCS"},{"code":"00078100768","type":"NDC"}],"standard_charges":[{"gross_charge":27567.35,"discounted_cash":27567.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"KCL (0.149%) IN NACL 20-0.45 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990925739","type":"NDC"}],"standard_charges":[{"gross_charge":120.01,"discounted_cash":120.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"ENOXAPARIN SODIUM 120 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001046242","type":"NDC"}],"standard_charges":[{"gross_charge":32.14,"discounted_cash":32.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.067 ML"}]},{"description":"AVASTIN 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":4007.5,"discounted_cash":4007.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"CAMPTOSAR 300 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00009008202","type":"NDC"}],"standard_charges":[{"gross_charge":242.37,"discounted_cash":242.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"XOLAIR 150 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021501","type":"NDC"}],"standard_charges":[{"gross_charge":3948.55,"discounted_cash":3948.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XOLAIR 150 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021503","type":"NDC"}],"standard_charges":[{"gross_charge":9685.93,"discounted_cash":9685.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"XOLAIR 75 MG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021403","type":"NDC"}],"standard_charges":[{"gross_charge":2430.79,"discounted_cash":2430.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"XOLAIR 75 MG/0.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2357","type":"HCPCS"},{"code":"50242021401","type":"NDC"}],"standard_charges":[{"gross_charge":2303.93,"discounted_cash":2303.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIBTAYO 350 MG/7ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9119","type":"HCPCS"},{"code":"61755000801","type":"NDC"}],"standard_charges":[{"gross_charge":33186.73,"discounted_cash":33186.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"TWINRIX 720-20 ELU-MCG/ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90636","type":"HCPCS"},{"code":"58160081552","type":"NDC"}],"standard_charges":[{"gross_charge":504.4,"discounted_cash":504.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROLIA 60 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0897","type":"HCPCS"},{"code":"55513071021","type":"NDC"}],"standard_charges":[{"gross_charge":6243.14,"discounted_cash":6243.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TECENTRIQ 840 MG/14ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091801","type":"NDC"}],"standard_charges":[{"gross_charge":32769.62,"discounted_cash":32769.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"LEQVIO 284 MG/1.5ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1306","type":"HCPCS"},{"code":"00078100060","type":"NDC"}],"standard_charges":[{"gross_charge":11795.02,"discounted_cash":11795.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043485","type":"NDC"}],"standard_charges":[{"gross_charge":24.64,"discounted_cash":24.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457029202","type":"NDC"}],"standard_charges":[{"gross_charge":22.56,"discounted_cash":22.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"00641618210","type":"NDC"}],"standard_charges":[{"gross_charge":63.72,"discounted_cash":63.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DIAZEPAM 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3360","type":"HCPCS"},{"code":"43598010610","type":"NDC"}],"standard_charges":[{"gross_charge":51.19,"discounted_cash":51.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781326268","type":"NDC"}],"standard_charges":[{"gross_charge":47.98,"discounted_cash":47.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00574082001","type":"NDC"}],"standard_charges":[{"gross_charge":71.22,"discounted_cash":71.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"68001045842","type":"NDC"}],"standard_charges":[{"gross_charge":43.74,"discounted_cash":43.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"VASOPRESSIN 20 UNIT/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2598","type":"HCPCS"},{"code":"00517102025","type":"NDC"}],"standard_charges":[{"gross_charge":47.14,"discounted_cash":47.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.05 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335005040","type":"NDC"}],"standard_charges":[{"gross_charge":3005.95,"discounted_cash":3005.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 25 ML"}]},{"description":"DICYCLOMINE HCL 10 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0500","type":"HCPCS"},{"code":"70069044105","type":"NDC"}],"standard_charges":[{"gross_charge":180.58,"discounted_cash":180.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HALOPERIDOL DECANOATE 100 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1631","type":"HCPCS"},{"code":"67457040913","type":"NDC"}],"standard_charges":[{"gross_charge":70.15,"discounted_cash":70.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560200","type":"NDC"}],"standard_charges":[{"gross_charge":52.01,"discounted_cash":52.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714001610","type":"NDC"}],"standard_charges":[{"gross_charge":84.42,"discounted_cash":84.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"14789012805","type":"NDC"}],"standard_charges":[{"gross_charge":150.11,"discounted_cash":150.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"81952012424","type":"NDC"}],"standard_charges":[{"gross_charge":68.48,"discounted_cash":68.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"16729047731","type":"NDC"}],"standard_charges":[{"gross_charge":800.84,"discounted_cash":800.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ISOSULFAN BLUE 1 % SC SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"67457022005","type":"NDC"}],"standard_charges":[{"gross_charge":383.84,"discounted_cash":383.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"BEVACIZUMAB 1.25 MG/0.05ML IZ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9257","type":"HCPCS"},{"code":"71266800601","type":"NDC"}],"standard_charges":[{"gross_charge":591.98,"discounted_cash":591.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"16714083401","type":"NDC"}],"standard_charges":[{"gross_charge":973.13,"discounted_cash":973.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714003610","type":"NDC"}],"standard_charges":[{"gross_charge":93.34,"discounted_cash":93.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"00143937910","type":"NDC"}],"standard_charges":[{"gross_charge":106.06,"discounted_cash":106.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"ERBITUX 200 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9055","type":"HCPCS"},{"code":"66733095823","type":"NDC"}],"standard_charges":[{"gross_charge":917.88,"discounted_cash":917.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM-SODIUM CHLORIDE 50-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2251","type":"HCPCS"},{"code":"44567061010","type":"NDC"}],"standard_charges":[{"gross_charge":213.51,"discounted_cash":213.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"FULPHILA 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"83257000541","type":"NDC"}],"standard_charges":[{"gross_charge":6054.74,"discounted_cash":6054.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"VECTIBIX 400 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9303","type":"HCPCS"},{"code":"55513095601","type":"NDC"}],"standard_charges":[{"gross_charge":21429.55,"discounted_cash":21429.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"AVASTIN 400 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006101","type":"NDC"}],"standard_charges":[{"gross_charge":10193.0,"discounted_cash":10193.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 16 ML"}]},{"description":"YERVOY 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"00003232711","type":"NDC"}],"standard_charges":[{"gross_charge":8520.66,"discounted_cash":8520.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"YERVOY 200 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9228","type":"HCPCS"},{"code":"00003232822","type":"NDC"}],"standard_charges":[{"gross_charge":39708.2,"discounted_cash":39708.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14.5 ML"}]},{"description":"ENGERIX-B 10 MCG/0.5ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082052","type":"NDC"}],"standard_charges":[{"gross_charge":210.82,"discounted_cash":210.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENGERIX-B 20 MCG/ML IJ SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"58160082152","type":"NDC"}],"standard_charges":[{"gross_charge":262.13,"discounted_cash":262.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DOXIL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"00338006301","type":"NDC"}],"standard_charges":[{"gross_charge":1674.15,"discounted_cash":1674.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234099","type":"NDC"}],"standard_charges":[{"gross_charge":173.64,"discounted_cash":173.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234010","type":"NDC"}],"standard_charges":[{"gross_charge":173.64,"discounted_cash":173.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517231005","type":"NDC"}],"standard_charges":[{"gross_charge":174.05,"discounted_cash":174.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"VENOFER 20 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1756","type":"HCPCS"},{"code":"00517234025","type":"NDC"}],"standard_charges":[{"gross_charge":173.64,"discounted_cash":173.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"RECOMBIVAX HB 10 MCG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90746","type":"HCPCS"},{"code":"00006499541","type":"NDC"}],"standard_charges":[{"gross_charge":210.62,"discounted_cash":210.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"67457052433","type":"NDC"}],"standard_charges":[{"gross_charge":289.0,"discounted_cash":289.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"55150044301","type":"NDC"}],"standard_charges":[{"gross_charge":484.99,"discounted_cash":484.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"55150040025","type":"NDC"}],"standard_charges":[{"gross_charge":69.17,"discounted_cash":69.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043592","type":"NDC"}],"standard_charges":[{"gross_charge":49.38,"discounted_cash":49.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00781324664","type":"NDC"}],"standard_charges":[{"gross_charge":39.83,"discounted_cash":39.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"TESTOSTERONE CYPIONATE 200 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1071","type":"HCPCS"},{"code":"00574082701","type":"NDC"}],"standard_charges":[{"gross_charge":61.11,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"FULVESTRANT 250 MG/5ML IM SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9395","type":"HCPCS"},{"code":"70860021174","type":"NDC"}],"standard_charges":[{"gross_charge":734.52,"discounted_cash":734.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"BENZTROPINE MESYLATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0515","type":"HCPCS"},{"code":"68382086010","type":"NDC"}],"standard_charges":[{"gross_charge":65.17,"discounted_cash":65.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"63323056497","type":"NDC"}],"standard_charges":[{"gross_charge":53.59,"discounted_cash":53.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ENOXAPARIN SODIUM 150 MG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714006610","type":"NDC"}],"standard_charges":[{"gross_charge":162.49,"discounted_cash":162.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OCTREOTIDE ACETATE 50 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2354","type":"HCPCS"},{"code":"00641617410","type":"NDC"}],"standard_charges":[{"gross_charge":37.92,"discounted_cash":37.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RETACRIT 2000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130510","type":"NDC"}],"standard_charges":[{"gross_charge":107.37,"discounted_cash":107.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RETACRIT 3000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130610","type":"NDC"}],"standard_charges":[{"gross_charge":154.9,"discounted_cash":154.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"RETACRIT 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130710","type":"NDC"}],"standard_charges":[{"gross_charge":78.29,"discounted_cash":78.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"RETACRIT 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130810","type":"NDC"}],"standard_charges":[{"gross_charge":248.55,"discounted_cash":248.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"RETACRIT 40000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5106","type":"HCPCS"},{"code":"00069130904","type":"NDC"}],"standard_charges":[{"gross_charge":484.0,"discounted_cash":484.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"EPINEPHRINE 1 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0171","type":"HCPCS"},{"code":"76329331801","type":"NDC"}],"standard_charges":[{"gross_charge":78.76,"discounted_cash":78.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FULPHILA 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5108","type":"HCPCS"},{"code":"67457083306","type":"NDC"}],"standard_charges":[{"gross_charge":5755.28,"discounted_cash":5755.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"FLUOROURACIL 5 GM/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"63323011761","type":"NDC"}],"standard_charges":[{"gross_charge":48.21,"discounted_cash":48.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PHENOBARBITAL SODIUM 65 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"42494041525","type":"NDC"}],"standard_charges":[{"gross_charge":75.35,"discounted_cash":75.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PHYTONADIONE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"43598040516","type":"NDC"}],"standard_charges":[{"gross_charge":46.31,"discounted_cash":46.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"72603019801","type":"NDC"}],"standard_charges":[{"gross_charge":58.78,"discounted_cash":58.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.375 ML"}]},{"description":"CLINDAMYCIN PHOSPHATE 300 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0736","type":"HCPCS"},{"code":"25021011502","type":"NDC"}],"standard_charges":[{"gross_charge":54.52,"discounted_cash":54.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"00641141035","type":"NDC"}],"standard_charges":[{"gross_charge":28.89,"discounted_cash":28.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"73177011603","type":"NDC"}],"standard_charges":[{"gross_charge":82.09,"discounted_cash":82.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"39822200001","type":"NDC"}],"standard_charges":[{"gross_charge":26.79,"discounted_cash":26.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"55150018310","type":"NDC"}],"standard_charges":[{"gross_charge":90.1,"discounted_cash":90.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"EPTIFIBATIDE 20 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1327","type":"HCPCS"},{"code":"55150021910","type":"NDC"}],"standard_charges":[{"gross_charge":112.09,"discounted_cash":112.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69374092005","type":"NDC"}],"standard_charges":[{"gross_charge":41.55,"discounted_cash":41.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"69374090205","type":"NDC"}],"standard_charges":[{"gross_charge":68.31,"discounted_cash":68.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"IRINOTECAN HCL 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"45963061455","type":"NDC"}],"standard_charges":[{"gross_charge":84.09,"discounted_cash":84.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323011805","type":"NDC"}],"standard_charges":[{"gross_charge":30.49,"discounted_cash":30.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"70121165701","type":"NDC"}],"standard_charges":[{"gross_charge":36.89,"discounted_cash":36.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL CITRATE PF 25 MCG/0.5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641624910","type":"NDC"}],"standard_charges":[{"gross_charge":37.06,"discounted_cash":37.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL 2 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020202","type":"NDC"}],"standard_charges":[{"gross_charge":15.67,"discounted_cash":15.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"HALOPERIDOL LACTATE 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1630","type":"HCPCS"},{"code":"76045073710","type":"NDC"}],"standard_charges":[{"gross_charge":17.66,"discounted_cash":17.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"NA FERRIC GLUC CPLX IN SUCROSE 12.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2916","type":"HCPCS"},{"code":"00143957010","type":"NDC"}],"standard_charges":[{"gross_charge":259.33,"discounted_cash":259.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041077","type":"NDC"}],"standard_charges":[{"gross_charge":24.95,"discounted_cash":24.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955100410","type":"NDC"}],"standard_charges":[{"gross_charge":38.58,"discounted_cash":38.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"25021041078","type":"NDC"}],"standard_charges":[{"gross_charge":24.3,"discounted_cash":24.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"HYDROMORPHONE HCL 0.25 MG/0.5ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"00409180501","type":"NDC"}],"standard_charges":[{"gross_charge":55.63,"discounted_cash":55.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"GENTAMICIN SULFATE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1580","type":"HCPCS"},{"code":"63323017302","type":"NDC"}],"standard_charges":[{"gross_charge":46.0,"discounted_cash":46.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"AMINOPHYLLINE 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"00409592201","type":"NDC"}],"standard_charges":[{"gross_charge":23.98,"discounted_cash":23.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288042296","type":"NDC"}],"standard_charges":[{"gross_charge":22.1,"discounted_cash":22.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"60505619301","type":"NDC"}],"standard_charges":[{"gross_charge":43.74,"discounted_cash":43.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016116","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016101","type":"NDC"}],"standard_charges":[{"gross_charge":19.5,"discounted_cash":19.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"25021070001","type":"NDC"}],"standard_charges":[{"gross_charge":21.36,"discounted_cash":21.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.667 ML"}]},{"description":"AMIODARONE HCL 450 MG/9ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0282","type":"HCPCS"},{"code":"63323061609","type":"NDC"}],"standard_charges":[{"gross_charge":41.87,"discounted_cash":41.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00143970201","type":"NDC"}],"standard_charges":[{"gross_charge":75.68,"discounted_cash":75.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"25021031802","type":"NDC"}],"standard_charges":[{"gross_charge":45.02,"discounted_cash":45.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"PROMETHAZINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"39822555006","type":"NDC"}],"standard_charges":[{"gross_charge":21.86,"discounted_cash":21.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"IRINOTECAN HCL 40 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"60505612800","type":"NDC"}],"standard_charges":[{"gross_charge":59.13,"discounted_cash":59.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.8 ML"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641624725","type":"NDC"}],"standard_charges":[{"gross_charge":19.23,"discounted_cash":19.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"FENTANYL CITRATE (PF) 50 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080601","type":"NDC"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":21.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"FENTANYL CITRATE PF 50 MCG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080811","type":"NDC"}],"standard_charges":[{"gross_charge":22.72,"discounted_cash":22.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"EVENITY 105 MG/1.17ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513088002","type":"NDC"}],"standard_charges":[{"gross_charge":7931.05,"discounted_cash":7931.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.34 ML"}]},{"description":"EVENITY 105 MG/1.17ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3111","type":"HCPCS"},{"code":"55513099802","type":"NDC"}],"standard_charges":[{"gross_charge":8991.52,"discounted_cash":8991.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.34 ML"}]},{"description":"KENALOG-80 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003031505","type":"NDC"}],"standard_charges":[{"gross_charge":101.54,"discounted_cash":101.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NUCALA 100 MG/ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2182","type":"HCPCS"},{"code":"00173089242","type":"NDC"}],"standard_charges":[{"gross_charge":12611.64,"discounted_cash":12611.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MVASI 100 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020601","type":"NDC"}],"standard_charges":[{"gross_charge":1093.64,"discounted_cash":1093.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028528","type":"NDC"}],"standard_charges":[{"gross_charge":89.61,"discounted_cash":89.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"NAROPIN 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028523","type":"NDC"}],"standard_charges":[{"gross_charge":29.54,"discounted_cash":29.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"NAROPIN 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028821","type":"NDC"}],"standard_charges":[{"gross_charge":81.72,"discounted_cash":81.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 40 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028635","type":"NDC"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DURAMORPH 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641601910","type":"NDC"}],"standard_charges":[{"gross_charge":109.23,"discounted_cash":109.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"63323066416","type":"NDC"}],"standard_charges":[{"gross_charge":14.0,"discounted_cash":14.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"MAGNESIUM SULFATE 50 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3475","type":"HCPCS"},{"code":"63323006443","type":"NDC"}],"standard_charges":[{"gross_charge":31.48,"discounted_cash":31.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"25021070101","type":"NDC"}],"standard_charges":[{"gross_charge":19.81,"discounted_cash":19.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"25021079120","type":"NDC"}],"standard_charges":[{"gross_charge":78.03,"discounted_cash":78.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288040202","type":"NDC"}],"standard_charges":[{"gross_charge":34.7,"discounted_cash":34.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00409163010","type":"NDC"}],"standard_charges":[{"gross_charge":42.15,"discounted_cash":42.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010105","type":"NDC"}],"standard_charges":[{"gross_charge":23.6,"discounted_cash":23.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"76329334001","type":"NDC"}],"standard_charges":[{"gross_charge":58.38,"discounted_cash":58.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"63323066501","type":"NDC"}],"standard_charges":[{"gross_charge":19.53,"discounted_cash":19.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022930","type":"NDC"}],"standard_charges":[{"gross_charge":49.04,"discounted_cash":49.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"55111068507","type":"NDC"}],"standard_charges":[{"gross_charge":37.35,"discounted_cash":37.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 ML"}]},{"description":"DEXAMETHASONE SOD PHOSPHATE PF 10 MG/ML INJ (WRAPPED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1100","type":"HCPCS"},{"code":"25021005301","type":"NDC"}],"standard_charges":[{"gross_charge":17.55,"discounted_cash":17.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"00703450204","type":"NDC"}],"standard_charges":[{"gross_charge":39.47,"discounted_cash":39.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457044220","type":"NDC"}],"standard_charges":[{"gross_charge":75.14,"discounted_cash":75.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"OXALIPLATIN 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"67457046910","type":"NDC"}],"standard_charges":[{"gross_charge":75.14,"discounted_cash":75.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.5 ML"}]},{"description":"LABETALOL HCL 10 MG/2ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1921","type":"HCPCS"},{"code":"00641625210","type":"NDC"}],"standard_charges":[{"gross_charge":57.09,"discounted_cash":57.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"00641600810","type":"NDC"}],"standard_charges":[{"gross_charge":36.57,"discounted_cash":36.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00338006910","type":"NDC"}],"standard_charges":[{"gross_charge":28.09,"discounted_cash":28.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"43598008758","type":"NDC"}],"standard_charges":[{"gross_charge":81.36,"discounted_cash":81.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075625","type":"NDC"}],"standard_charges":[{"gross_charge":21.67,"discounted_cash":21.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"10019012001","type":"NDC"}],"standard_charges":[{"gross_charge":38.82,"discounted_cash":38.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"CLONIDINE HCL (ANALGESIA) 100 MCG/ML EP SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0735","type":"HCPCS"},{"code":"00143972401","type":"NDC"}],"standard_charges":[{"gross_charge":24.23,"discounted_cash":24.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"DIGOXIN 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1160","type":"HCPCS"},{"code":"00781305995","type":"NDC"}],"standard_charges":[{"gross_charge":26.62,"discounted_cash":26.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"55111069407","type":"NDC"}],"standard_charges":[{"gross_charge":55.73,"discounted_cash":55.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022995","type":"NDC"}],"standard_charges":[{"gross_charge":41.71,"discounted_cash":41.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"76329332100","type":"NDC"}],"standard_charges":[{"gross_charge":65.04,"discounted_cash":65.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LACOSAMIDE 200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9254","type":"HCPCS"},{"code":"69543045510","type":"NDC"}],"standard_charges":[{"gross_charge":84.53,"discounted_cash":84.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROTAMINE SULFATE 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2720","type":"HCPCS"},{"code":"63323022994","type":"NDC"}],"standard_charges":[{"gross_charge":23.95,"discounted_cash":23.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"67457031725","type":"NDC"}],"standard_charges":[{"gross_charge":71.48,"discounted_cash":71.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MEPERIDINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00641605325","type":"NDC"}],"standard_charges":[{"gross_charge":24.98,"discounted_cash":24.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"00409188602","type":"NDC"}],"standard_charges":[{"gross_charge":34.31,"discounted_cash":34.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323096505","type":"NDC"}],"standard_charges":[{"gross_charge":48.31,"discounted_cash":48.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ESMOLOL HCL 2500 MG/250ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1806","type":"HCPCS"},{"code":"44567081110","type":"NDC"}],"standard_charges":[{"gross_charge":615.89,"discounted_cash":615.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ESMOLOL HCL 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1805","type":"HCPCS"},{"code":"67457018210","type":"NDC"}],"standard_charges":[{"gross_charge":52.68,"discounted_cash":52.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"72603013325","type":"NDC"}],"standard_charges":[{"gross_charge":26.98,"discounted_cash":26.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"72485010610","type":"NDC"}],"standard_charges":[{"gross_charge":45.79,"discounted_cash":45.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ZOLEDRONIC ACID 5 MG/100ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"67457061910","type":"NDC"}],"standard_charges":[{"gross_charge":281.55,"discounted_cash":281.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"GEMCITABINE HCL 2 GM/52.6ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"67457061810","type":"NDC"}],"standard_charges":[{"gross_charge":87.71,"discounted_cash":87.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5.26 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"25021067510","type":"NDC"}],"standard_charges":[{"gross_charge":39.4,"discounted_cash":39.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"63323016201","type":"NDC"}],"standard_charges":[{"gross_charge":16.06,"discounted_cash":16.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"00409018101","type":"NDC"}],"standard_charges":[{"gross_charge":273.55,"discounted_cash":273.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 22.2 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70860078101","type":"NDC"}],"standard_charges":[{"gross_charge":25.92,"discounted_cash":25.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LEVETIRACETAM 500 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1953","type":"HCPCS"},{"code":"00143967325","type":"NDC"}],"standard_charges":[{"gross_charge":22.93,"discounted_cash":22.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"VITAMIN K1 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3430","type":"HCPCS"},{"code":"00409915801","type":"NDC"}],"standard_charges":[{"gross_charge":45.22,"discounted_cash":45.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"KCL (0.149%) IN NACL 20-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711509","type":"NDC"}],"standard_charges":[{"gross_charge":120.01,"discounted_cash":120.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 20-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00264786500","type":"NDC"}],"standard_charges":[{"gross_charge":52.76,"discounted_cash":52.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"63323068810","type":"NDC"}],"standard_charges":[{"gross_charge":79.66,"discounted_cash":79.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KCL (0.298%) IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00990711609","type":"NDC"}],"standard_charges":[{"gross_charge":85.01,"discounted_cash":85.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"POTASSIUM CHLORIDE IN NACL 40-0.9 MEQ/L-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00338069504","type":"NDC"}],"standard_charges":[{"gross_charge":99.53,"discounted_cash":99.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1000 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"62332059925","type":"NDC"}],"standard_charges":[{"gross_charge":32.17,"discounted_cash":32.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FENTANYL CITRATE PF 50 MCG/ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00641624810","type":"NDC"}],"standard_charges":[{"gross_charge":28.57,"discounted_cash":28.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"72485010125","type":"NDC"}],"standard_charges":[{"gross_charge":16.92,"discounted_cash":16.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"PAMIDRONATE DISODIUM 30 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"67457043010","type":"NDC"}],"standard_charges":[{"gross_charge":71.18,"discounted_cash":71.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE HCL (PF) 4 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409428301","type":"NDC"}],"standard_charges":[{"gross_charge":14.15,"discounted_cash":14.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"MORPHINE SULFATE (PF) 0.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409381412","type":"NDC"}],"standard_charges":[{"gross_charge":38.26,"discounted_cash":38.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"63323057812","type":"NDC"}],"standard_charges":[{"gross_charge":22.93,"discounted_cash":22.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"ZOLEDRONIC ACID 4 MG/5ML IV CONC","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3489","type":"HCPCS"},{"code":"43598023311","type":"NDC"}],"standard_charges":[{"gross_charge":43.0,"discounted_cash":43.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.75 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143968910","type":"NDC"}],"standard_charges":[{"gross_charge":14.1,"discounted_cash":14.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.08 ML"}]},{"description":"METHOTREXATE SODIUM (PF) 50 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9260","type":"HCPCS"},{"code":"00143951910","type":"NDC"}],"standard_charges":[{"gross_charge":34.17,"discounted_cash":34.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.16 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"69374091910","type":"NDC"}],"standard_charges":[{"gross_charge":54.47,"discounted_cash":54.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.8 ML"}]},{"description":"GLYCOPYRROLATE 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1598","type":"HCPCS"},{"code":"63323057811","type":"NDC"}],"standard_charges":[{"gross_charge":37.43,"discounted_cash":37.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TERBUTALINE SULFATE 1 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3105","type":"HCPCS"},{"code":"00143974610","type":"NDC"}],"standard_charges":[{"gross_charge":19.29,"discounted_cash":19.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"LABETALOL HCL 20 MG/4ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"71506004645","type":"NDC"}],"standard_charges":[{"gross_charge":47.55,"discounted_cash":47.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00641040012","type":"NDC"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":38.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 5 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"71449012511","type":"NDC"}],"standard_charges":[{"gross_charge":54.03,"discounted_cash":54.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"67457059902","type":"NDC"}],"standard_charges":[{"gross_charge":48.71,"discounted_cash":48.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"70092108746","type":"NDC"}],"standard_charges":[{"gross_charge":62.55,"discounted_cash":62.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00409140101","type":"NDC"}],"standard_charges":[{"gross_charge":83.81,"discounted_cash":83.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MORPHINE SULFATE 1 MG/ML IJ SOLN (WRAPPED)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"70092113343","type":"NDC"}],"standard_charges":[{"gross_charge":70.48,"discounted_cash":70.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ENOXAPARIN SODIUM 80 MG/0.8ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71839011210","type":"NDC"}],"standard_charges":[{"gross_charge":24.86,"discounted_cash":24.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043383","type":"NDC"}],"standard_charges":[{"gross_charge":38.4,"discounted_cash":38.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"63323067389","type":"NDC"}],"standard_charges":[{"gross_charge":112.04,"discounted_cash":112.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"ENOXAPARIN SODIUM 60 MG/0.6ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714002610","type":"NDC"}],"standard_charges":[{"gross_charge":42.6,"discounted_cash":42.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"ENOXAPARIN SODIUM 40 MG/0.4ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043392","type":"NDC"}],"standard_charges":[{"gross_charge":43.81,"discounted_cash":43.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"16714000610","type":"NDC"}],"standard_charges":[{"gross_charge":46.35,"discounted_cash":46.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"16729050008","type":"NDC"}],"standard_charges":[{"gross_charge":59.02,"discounted_cash":59.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 8 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"68462075525","type":"NDC"}],"standard_charges":[{"gross_charge":23.83,"discounted_cash":23.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.667 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"65219063019","type":"NDC"}],"standard_charges":[{"gross_charge":126.45,"discounted_cash":126.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"63323080602","type":"NDC"}],"standard_charges":[{"gross_charge":20.66,"discounted_cash":20.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CYTARABINE (PF) 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9100","type":"HCPCS"},{"code":"61703030538","type":"NDC"}],"standard_charges":[{"gross_charge":80.18,"discounted_cash":80.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00143954210","type":"NDC"}],"standard_charges":[{"gross_charge":78.26,"discounted_cash":78.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FENTANYL CITRATE (PF) 100 MCG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3010","type":"HCPCS"},{"code":"00409909422","type":"NDC"}],"standard_charges":[{"gross_charge":17.45,"discounted_cash":17.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"SUCCINYLCHOLINE CHLORIDE 200 MG/10ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0330","type":"HCPCS"},{"code":"71266200102","type":"NDC"}],"standard_charges":[{"gross_charge":50.21,"discounted_cash":50.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"INJECTAFER 750 MG/15ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1439","type":"HCPCS"},{"code":"00517065001","type":"NDC"}],"standard_charges":[{"gross_charge":200.9,"discounted_cash":200.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"SIMPONI ARIA 50 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1602","type":"HCPCS"},{"code":"57894035001","type":"NDC"}],"standard_charges":[{"gross_charge":1672.08,"discounted_cash":1672.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"MARCAINE 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409158210","type":"NDC"}],"standard_charges":[{"gross_charge":54.39,"discounted_cash":54.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048717","type":"NDC"}],"standard_charges":[{"gross_charge":23.1,"discounted_cash":23.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048731","type":"NDC"}],"standard_charges":[{"gross_charge":43.44,"discounted_cash":43.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 1 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048737","type":"NDC"}],"standard_charges":[{"gross_charge":16.32,"discounted_cash":16.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048927","type":"NDC"}],"standard_charges":[{"gross_charge":46.23,"discounted_cash":46.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"XYLOCAINE-MPF/EPINEPHRINE 2 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"63323048917","type":"NDC"}],"standard_charges":[{"gross_charge":46.99,"discounted_cash":46.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"ATIVAN 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641600125","type":"NDC"}],"standard_charges":[{"gross_charge":17.41,"discounted_cash":17.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"ATIVAN 4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641600325","type":"NDC"}],"standard_charges":[{"gross_charge":26.35,"discounted_cash":26.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"OXALIPLATIN 100 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9263","type":"HCPCS"},{"code":"00703398601","type":"NDC"}],"standard_charges":[{"gross_charge":267.28,"discounted_cash":267.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4.5 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061416","type":"NDC"}],"standard_charges":[{"gross_charge":18.93,"discounted_cash":18.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ORPHENADRINE CITRATE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2360","type":"HCPCS"},{"code":"25021065102","type":"NDC"}],"standard_charges":[{"gross_charge":42.91,"discounted_cash":42.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"DROPERIDOL 2.5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1790","type":"HCPCS"},{"code":"00143951525","type":"NDC"}],"standard_charges":[{"gross_charge":33.02,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379501","type":"NDC"}],"standard_charges":[{"gross_charge":33.2,"discounted_cash":33.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"62332060025","type":"NDC"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"65219036802","type":"NDC"}],"standard_charges":[{"gross_charge":27.21,"discounted_cash":27.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LABETALOL HCL 5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"69374094634","type":"NDC"}],"standard_charges":[{"gross_charge":23.98,"discounted_cash":23.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"MORPHINE SULFATE (PF) 10 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00409189301","type":"NDC"}],"standard_charges":[{"gross_charge":23.81,"discounted_cash":23.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"43598061611","type":"NDC"}],"standard_charges":[{"gross_charge":71.69,"discounted_cash":71.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"TRIAMCINOLONE ACETONIDE 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"81298578105","type":"NDC"}],"standard_charges":[{"gross_charge":26.7,"discounted_cash":26.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"NICARDIPINE HCL 2.5 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2404","type":"HCPCS"},{"code":"00517073510","type":"NDC"}],"standard_charges":[{"gross_charge":121.35,"discounted_cash":121.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHOCARBAMOL 1000 MG/10ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2800","type":"HCPCS"},{"code":"63323077810","type":"NDC"}],"standard_charges":[{"gross_charge":59.78,"discounted_cash":59.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MIDAZOLAM HCL (PF) 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2250","type":"HCPCS"},{"code":"00409230801","type":"NDC"}],"standard_charges":[{"gross_charge":14.18,"discounted_cash":14.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"GLYCOPYRROLATE 0.4 MG/2ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"00517460225","type":"NDC"}],"standard_charges":[{"gross_charge":23.76,"discounted_cash":23.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"75834017119","type":"NDC"}],"standard_charges":[{"gross_charge":152.5,"discounted_cash":152.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 5000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272301","type":"NDC"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"LORAZEPAM 2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2060","type":"HCPCS"},{"code":"00641604425","type":"NDC"}],"standard_charges":[{"gross_charge":15.7,"discounted_cash":15.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.13 ML"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641149535","type":"NDC"}],"standard_charges":[{"gross_charge":21.05,"discounted_cash":21.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"FUROSEMIDE 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1940","type":"HCPCS"},{"code":"00409610202","type":"NDC"}],"standard_charges":[{"gross_charge":48.66,"discounted_cash":48.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00409272101","type":"NDC"}],"standard_charges":[{"gross_charge":13.52,"discounted_cash":13.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.034 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"76045010210","type":"NDC"}],"standard_charges":[{"gross_charge":22.92,"discounted_cash":22.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"ZINPLAVA 1000 MG/40ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0565","type":"HCPCS"},{"code":"00006302500","type":"NDC"}],"standard_charges":[{"gross_charge":3743.84,"discounted_cash":3743.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 11.5 ML"}]},{"description":"ADENOSINE 12 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065104","type":"NDC"}],"standard_charges":[{"gross_charge":63.18,"discounted_cash":63.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"STELARA 130 MG/26ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3358","type":"HCPCS"},{"code":"57894005427","type":"NDC"}],"standard_charges":[{"gross_charge":28523.73,"discounted_cash":28523.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 104 ML"}]},{"description":"HYDROMORPHONE HCL-NACL 20-0.9 MG/100ML-% IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092111675","type":"NDC"}],"standard_charges":[{"gross_charge":282.99,"discounted_cash":282.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"DOXORUBICIN HCL LIPOSOMAL 2 MG/ML IV SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q2050","type":"HCPCS"},{"code":"47335004940","type":"NDC"}],"standard_charges":[{"gross_charge":1221.0,"discounted_cash":1221.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"IRINOTECAN HCL 100 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9206","type":"HCPCS"},{"code":"00143970101","type":"NDC"}],"standard_charges":[{"gross_charge":85.81,"discounted_cash":85.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GLYCOPYRROLATE PF 0.4 MG/2ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1596","type":"HCPCS"},{"code":"70121169907","type":"NDC"}],"standard_charges":[{"gross_charge":43.23,"discounted_cash":43.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"00641039112","type":"NDC"}],"standard_charges":[{"gross_charge":73.86,"discounted_cash":73.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3.6 ML"}]},{"description":"PHENOBARBITAL SODIUM 130 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2560","type":"HCPCS"},{"code":"00641047725","type":"NDC"}],"standard_charges":[{"gross_charge":160.45,"discounted_cash":160.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PALONOSETRON HCL 0.25 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2469","type":"HCPCS"},{"code":"00781331275","type":"NDC"}],"standard_charges":[{"gross_charge":510.21,"discounted_cash":510.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"DESMOPRESSIN ACETATE PF 4 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2597","type":"HCPCS"},{"code":"25021046001","type":"NDC"}],"standard_charges":[{"gross_charge":76.31,"discounted_cash":76.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"COCAINE HCL 40 MG/ML NA SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"C9046","type":"HCPCS"},{"code":"70839036204","type":"NDC"}],"standard_charges":[{"gross_charge":768.09,"discounted_cash":768.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"IBANDRONATE SODIUM 3 MG/3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1740","type":"HCPCS"},{"code":"60505609700","type":"NDC"}],"standard_charges":[{"gross_charge":398.67,"discounted_cash":398.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"MEDROXYPROGESTERONE ACETATE 150 MG/ML IM SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1050","type":"HCPCS"},{"code":"66993037083","type":"NDC"}],"standard_charges":[{"gross_charge":199.35,"discounted_cash":199.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"71288043281","type":"NDC"}],"standard_charges":[{"gross_charge":44.21,"discounted_cash":44.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00548560100","type":"NDC"}],"standard_charges":[{"gross_charge":42.11,"discounted_cash":42.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"VINORELBINE TARTRATE 50 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9390","type":"HCPCS"},{"code":"45963060756","type":"NDC"}],"standard_charges":[{"gross_charge":266.37,"discounted_cash":266.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"70069007110","type":"NDC"}],"standard_charges":[{"gross_charge":67.2,"discounted_cash":67.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NALBUPHINE HCL 10 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2300","type":"HCPCS"},{"code":"00409146301","type":"NDC"}],"standard_charges":[{"gross_charge":42.94,"discounted_cash":42.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157401","type":"NDC"}],"standard_charges":[{"gross_charge":30.16,"discounted_cash":30.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1010","type":"HCPCS"},{"code":"70121157405","type":"NDC"}],"standard_charges":[{"gross_charge":54.04,"discounted_cash":54.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"METHYLPREDNISOLONE ACETATE 80 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1040","type":"HCPCS"},{"code":"60219157405","type":"NDC"}],"standard_charges":[{"gross_charge":54.04,"discounted_cash":54.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"FLEXBUMIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"00944049506","type":"NDC"}],"standard_charges":[{"gross_charge":324.59,"discounted_cash":324.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"UDENYCA ONBODY 6 MG/0.6ML SC SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5111","type":"HCPCS"},{"code":"70114013001","type":"NDC"}],"standard_charges":[{"gross_charge":11422.35,"discounted_cash":11422.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.6 ML"}]},{"description":"LIDOCAINE HCL 100 MG/5ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"76329339001","type":"NDC"}],"standard_charges":[{"gross_charge":55.44,"discounted_cash":55.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL (CARDIAC) 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409490334","type":"NDC"}],"standard_charges":[{"gross_charge":32.97,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LIDOCAINE HCL (CARDIAC) PF 100 MG/5ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409132305","type":"NDC"}],"standard_charges":[{"gross_charge":47.6,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2.5 ML"}]},{"description":"TECENTRIQ 1200 MG/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9022","type":"HCPCS"},{"code":"50242091701","type":"NDC"}],"standard_charges":[{"gross_charge":33494.05,"discounted_cash":33494.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"FLUAD 0.5 ML IM SUSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"90653","type":"HCPCS"},{"code":"70461002403","type":"NDC"}],"standard_charges":[{"gross_charge":160.55,"discounted_cash":160.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.25 ML"}]},{"description":"PROVAYBLUE 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"00517038105","type":"NDC"}],"standard_charges":[{"gross_charge":397.15,"discounted_cash":397.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METHYLENE BLUE 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"70710183805","type":"NDC"}],"standard_charges":[{"gross_charge":603.74,"discounted_cash":603.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"PROVAYBLUE 50 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q9968","type":"HCPCS"},{"code":"00517037405","type":"NDC"}],"standard_charges":[{"gross_charge":45.12,"discounted_cash":45.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.4 ML"}]},{"description":"NESACAINE-MPF 3 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2401","type":"HCPCS"},{"code":"63323047827","type":"NDC"}],"standard_charges":[{"gross_charge":33.64,"discounted_cash":33.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"HYDROMORPHONE HCL-NACL 10-0.9 MG/50ML-% IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"70092128674","type":"NDC"}],"standard_charges":[{"gross_charge":341.23,"discounted_cash":341.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"FERUMOXYTOL 510 MG/17ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q0138","type":"HCPCS"},{"code":"00781315401","type":"NDC"}],"standard_charges":[{"gross_charge":894.14,"discounted_cash":894.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 17 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"00641625301","type":"NDC"}],"standard_charges":[{"gross_charge":80.22,"discounted_cash":80.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"HYDRALAZINE HCL 20 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0360","type":"HCPCS"},{"code":"63323061401","type":"NDC"}],"standard_charges":[{"gross_charge":18.94,"discounted_cash":18.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"ENOXAPARIN SODIUM 30 MG/0.3ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1650","type":"HCPCS"},{"code":"00955100310","type":"NDC"}],"standard_charges":[{"gross_charge":46.62,"discounted_cash":46.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.3 ML"}]},{"description":"TOPOTECAN HCL 4 MG/4ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9351","type":"HCPCS"},{"code":"00409030201","type":"NDC"}],"standard_charges":[{"gross_charge":145.35,"discounted_cash":145.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.15 ML"}]},{"description":"VINCRISTINE SULFATE 1 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9370","type":"HCPCS"},{"code":"61703030906","type":"NDC"}],"standard_charges":[{"gross_charge":170.04,"discounted_cash":170.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521401","type":"NDC"}],"standard_charges":[{"gross_charge":270.14,"discounted_cash":270.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521902","type":"NDC"}],"standard_charges":[{"gross_charge":354.23,"discounted_cash":354.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"ALBUTEIN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68516521804","type":"NDC"}],"standard_charges":[{"gross_charge":268.33,"discounted_cash":268.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68982062302","type":"NDC"}],"standard_charges":[{"gross_charge":293.74,"discounted_cash":293.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 250 ML"}]},{"description":"ALBUMIN HUMAN 5 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9045","type":"HCPCS"},{"code":"68982062303","type":"NDC"}],"standard_charges":[{"gross_charge":394.15,"discounted_cash":394.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 500 ML"}]},{"description":"MARCAINE SPINAL 0.75-8.25 % IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409176110","type":"NDC"}],"standard_charges":[{"gross_charge":23.07,"discounted_cash":23.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"BUPIVACAINE SPINAL 0.75-8.25 % IT SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"00409361301","type":"NDC"}],"standard_charges":[{"gross_charge":19.54,"discounted_cash":19.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.1 ML"}]},{"description":"EPOGEN 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513014410","type":"NDC"}],"standard_charges":[{"gross_charge":558.95,"discounted_cash":558.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROCRIT 10000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676031001","type":"NDC"}],"standard_charges":[{"gross_charge":459.84,"discounted_cash":459.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROCRIT 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"59676030401","type":"NDC"}],"standard_charges":[{"gross_charge":409.89,"discounted_cash":409.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"EPOGEN 4000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0885","type":"HCPCS"},{"code":"55513014810","type":"NDC"}],"standard_charges":[{"gross_charge":423.39,"discounted_cash":423.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1.25 ML"}]},{"description":"KENALOG-40 40 MG/ML IJ SUSP","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3301","type":"HCPCS"},{"code":"00003029305","type":"NDC"}],"standard_charges":[{"gross_charge":19.92,"discounted_cash":19.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.038 ML"}]},{"description":"TIGAN 100 MG/ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3250","type":"HCPCS"},{"code":"42023011925","type":"NDC"}],"standard_charges":[{"gross_charge":260.23,"discounted_cash":260.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"55150019301","type":"NDC"}],"standard_charges":[{"gross_charge":473.7,"discounted_cash":473.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"ADENOSINE (DIAGNOSTIC) 3 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"23155025832","type":"NDC"}],"standard_charges":[{"gross_charge":42.72,"discounted_cash":42.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"ALBUMIN HUMAN 25 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"P9046","type":"HCPCS"},{"code":"68982064302","type":"NDC"}],"standard_charges":[{"gross_charge":400.13,"discounted_cash":400.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 100 ML"}]},{"description":"MVASI 400 MG/16ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5107","type":"HCPCS"},{"code":"55513020701","type":"NDC"}],"standard_charges":[{"gross_charge":2156.22,"discounted_cash":2156.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"DILAUDID 0.2 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1171","type":"HCPCS"},{"code":"76045012111","type":"NDC"}],"standard_charges":[{"gross_charge":55.71,"discounted_cash":55.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"TRUXIMA 100 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010310","type":"NDC"}],"standard_charges":[{"gross_charge":1754.97,"discounted_cash":1754.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"TRUXIMA 500 MG/50ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"Q5115","type":"HCPCS"},{"code":"63459010450","type":"NDC"}],"standard_charges":[{"gross_charge":8865.63,"discounted_cash":8865.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 50 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028627","type":"NDC"}],"standard_charges":[{"gross_charge":20.32,"discounted_cash":20.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028631","type":"NDC"}],"standard_charges":[{"gross_charge":66.78,"discounted_cash":66.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 30 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028623","type":"NDC"}],"standard_charges":[{"gross_charge":50.84,"discounted_cash":50.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"NAROPIN 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2795","type":"HCPCS"},{"code":"63323028638","type":"NDC"}],"standard_charges":[{"gross_charge":31.2,"discounted_cash":31.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"MORPHINE SULFATE 8 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2270","type":"HCPCS"},{"code":"00641612625","type":"NDC"}],"standard_charges":[{"gross_charge":42.58,"discounted_cash":42.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.75 ML"}]},{"description":"SENSORCAINE-MPF 0.75 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0665","type":"HCPCS"},{"code":"63323047237","type":"NDC"}],"standard_charges":[{"gross_charge":16.2,"discounted_cash":16.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"71288041996","type":"NDC"}],"standard_charges":[{"gross_charge":40.56,"discounted_cash":40.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"PAMIDRONATE DISODIUM 90 MG/10ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2430","type":"HCPCS"},{"code":"61703032618","type":"NDC"}],"standard_charges":[{"gross_charge":160.14,"discounted_cash":160.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"LIDOCAINE-SODIUM BICARBONATE 1-8.4 % IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"70092117546","type":"NDC"}],"standard_charges":[{"gross_charge":65.97,"discounted_cash":65.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 20 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"00641037625","type":"NDC"}],"standard_charges":[{"gross_charge":13.97,"discounted_cash":13.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.125 ML"}]},{"description":"CALCIUM GLUCONATE 10 % IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0612","type":"HCPCS"},{"code":"00143918025","type":"NDC"}],"standard_charges":[{"gross_charge":57.03,"discounted_cash":57.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"FLUOROURACIL 1 GM/20ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9190","type":"HCPCS"},{"code":"70700018723","type":"NDC"}],"standard_charges":[{"gross_charge":121.77,"discounted_cash":121.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 7 ML"}]},{"description":"LIDOCAINE-EPINEPHRINE (PF) 1.5 %-1:200000 IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2004","type":"HCPCS"},{"code":"00409120901","type":"NDC"}],"standard_charges":[{"gross_charge":14.99,"discounted_cash":14.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"DIPHENHYDRAMINE HCL 50 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1200","type":"HCPCS"},{"code":"25021048101","type":"NDC"}],"standard_charges":[{"gross_charge":18.77,"discounted_cash":18.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266023425","type":"NDC"}],"standard_charges":[{"gross_charge":33.78,"discounted_cash":33.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72603015325","type":"NDC"}],"standard_charges":[{"gross_charge":30.1,"discounted_cash":30.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"GEMCITABINE HCL 1 GM/26.3ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J9201","type":"HCPCS"},{"code":"71288011728","type":"NDC"}],"standard_charges":[{"gross_charge":388.63,"discounted_cash":388.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 26.3 ML"}]},{"description":"KETOROLAC TROMETHAMINE 30 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"72266011825","type":"NDC"}],"standard_charges":[{"gross_charge":25.1,"discounted_cash":25.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"69374052005","type":"NDC"}],"standard_charges":[{"gross_charge":36.89,"discounted_cash":36.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"KETOROLAC TROMETHAMINE 60 MG/2ML IM SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379601","type":"NDC"}],"standard_charges":[{"gross_charge":22.41,"discounted_cash":22.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.33 ML"}]},{"description":"AMINOPHYLLINE 25 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0280","type":"HCPCS"},{"code":"00409592101","type":"NDC"}],"standard_charges":[{"gross_charge":30.94,"discounted_cash":30.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.5 ML"}]},{"description":"CYANOCOBALAMIN 1000 MCG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3420","type":"HCPCS"},{"code":"00143962125","type":"NDC"}],"standard_charges":[{"gross_charge":37.88,"discounted_cash":37.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"LABETALOL HCL 20 MG/4ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1920","type":"HCPCS"},{"code":"70092100944","type":"NDC"}],"standard_charges":[{"gross_charge":67.57,"discounted_cash":67.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"36000030810","type":"NDC"}],"standard_charges":[{"gross_charge":23.83,"discounted_cash":23.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"HEPARIN SODIUM (PORCINE) PF 1000 UNIT/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1644","type":"HCPCS"},{"code":"63323027601","type":"NDC"}],"standard_charges":[{"gross_charge":82.3,"discounted_cash":82.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"NALOXONE HCL 0.4 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2310","type":"HCPCS"},{"code":"55150032710","type":"NDC"}],"standard_charges":[{"gross_charge":83.94,"discounted_cash":83.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"KETOROLAC TROMETHAMINE 15 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1885","type":"HCPCS"},{"code":"00409379325","type":"NDC"}],"standard_charges":[{"gross_charge":52.12,"discounted_cash":52.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"NEOSTIGMINE METHYLSULFATE 3 MG/3ML IV SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2710","type":"HCPCS"},{"code":"76045038330","type":"NDC"}],"standard_charges":[{"gross_charge":70.52,"discounted_cash":70.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 3 ML"}]},{"description":"POTASSIUM CHLORIDE 2 MEQ/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J3480","type":"HCPCS"},{"code":"00409663501","type":"NDC"}],"standard_charges":[{"gross_charge":91.95,"discounted_cash":91.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 10 ML"}]},{"description":"METOCLOPRAMIDE HCL 5 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2765","type":"HCPCS"},{"code":"83634077941","type":"NDC"}],"standard_charges":[{"gross_charge":35.01,"discounted_cash":35.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"ACETYLCYSTEINE 200 MG/ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0132","type":"HCPCS"},{"code":"63323096330","type":"NDC"}],"standard_charges":[{"gross_charge":70.87,"discounted_cash":70.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 14 ML"}]},{"description":"ADENOSINE 6 MG/2ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0153","type":"HCPCS"},{"code":"63323065102","type":"NDC"}],"standard_charges":[{"gross_charge":18.96,"discounted_cash":18.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.22 ML"}]},{"description":"ATROPINE SULFATE 1 MG/10ML IJ SOSY","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J0461","type":"HCPCS"},{"code":"00409491134","type":"NDC"}],"standard_charges":[{"gross_charge":42.81,"discounted_cash":42.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 2 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"67457099405","type":"NDC"}],"standard_charges":[{"gross_charge":55.66,"discounted_cash":55.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"LIDOCAINE HCL 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"63323020102","type":"NDC"}],"standard_charges":[{"gross_charge":32.33,"discounted_cash":32.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"PROMETHAZINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2550","type":"HCPCS"},{"code":"00641092825","type":"NDC"}],"standard_charges":[{"gross_charge":19.43,"discounted_cash":19.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"REGADENOSON 0.4 MG/5ML IV SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2785","type":"HCPCS"},{"code":"71288020185","type":"NDC"}],"standard_charges":[{"gross_charge":63.09,"discounted_cash":63.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 5 ML"}]},{"description":"MEPERIDINE HCL 25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2175","type":"HCPCS"},{"code":"00641605225","type":"NDC"}],"standard_charges":[{"gross_charge":22.05,"discounted_cash":22.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 0.2 ML"}]},{"description":"BUMETANIDE 0.25 MG/ML IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J1939","type":"HCPCS"},{"code":"65219057004","type":"NDC"}],"standard_charges":[{"gross_charge":40.6,"discounted_cash":40.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 4 ML"}]},{"description":"LIDOCAINE HCL (PF) 1 % IJ SOLN","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"636","type":"RC"},{"code":"J2003","type":"HCPCS"},{"code":"00409471332","type":"NDC"}],"standard_charges":[{"gross_charge":24.62,"discounted_cash":24.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 1 ML"}]},{"description":"BANOPHEN 2-0.1 % EX CREA","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"259","type":"RC"},{"code":"00904535431","type":"NDC"}],"standard_charges":[{"gross_charge":29.02,"discounted_cash":29.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | NDC EA = 28 GR"}]},{"description":"HC GENERAL ROOM WITH TELEMETRY DAILY","code_information":[{"code":"1200000002","type":"CDM"},{"code":"0121","type":"RC"}],"standard_charges":[{"gross_charge":2532.48,"discounted_cash":2532.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - SNF","code_information":[{"code":"1200000003","type":"CDM"},{"code":"0120","type":"RC"}],"standard_charges":[{"gross_charge":1279.66,"discounted_cash":1279.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - MED/SURG","code_information":[{"code":"1210000001","type":"CDM"},{"code":"0121","type":"RC"}],"standard_charges":[{"gross_charge":2532.48,"discounted_cash":2532.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - BH ADULT","code_information":[{"code":"1240000002","type":"CDM"},{"code":"0124","type":"RC"}],"standard_charges":[{"gross_charge":2532.48,"discounted_cash":2532.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HOSPICE SEMI-PRIVATE ROOM DAILY","code_information":[{"code":"1250000001","type":"CDM"},{"code":"0125","type":"RC"}],"standard_charges":[{"gross_charge":2532.48,"discounted_cash":2532.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC R&B SEMI-PRIVATE ROOM DAILY - BH CHEMICAL","code_information":[{"code":"1260000001","type":"CDM"},{"code":"0126","type":"RC"}],"standard_charges":[{"gross_charge":2532.48,"discounted_cash":2532.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC R&B - SUBACUTE LEVEL 1","code_information":[{"code":"1910000001","type":"CDM"},{"code":"0191","type":"RC"}],"standard_charges":[{"gross_charge":1093.7,"discounted_cash":1093.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC R&B - SUBACUTE LEVEL 2","code_information":[{"code":"1920000001","type":"CDM"},{"code":"0192","type":"RC"}],"standard_charges":[{"gross_charge":1248.18,"discounted_cash":1248.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC R&B - SUBACUTE LEVEL 3","code_information":[{"code":"1930000001","type":"CDM"},{"code":"0193","type":"RC"}],"standard_charges":[{"gross_charge":1560.1,"discounted_cash":1560.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ICU ROOM DAILY","code_information":[{"code":"2000000001","type":"CDM"},{"code":"0200","type":"RC"}],"standard_charges":[{"gross_charge":4768.05,"discounted_cash":4768.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ICU MEDICAL ROOM DAILY","code_information":[{"code":"2020000001","type":"CDM"},{"code":"0202","type":"RC"}],"standard_charges":[{"gross_charge":4768.05,"discounted_cash":4768.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTERMEDIATE ICU ROOM DAILY","code_information":[{"code":"2060000001","type":"CDM"},{"code":"0206","type":"RC"}],"standard_charges":[{"gross_charge":3310.79,"discounted_cash":3310.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTERMEDIATE CCU ROOM DAILY","code_information":[{"code":"2140000001","type":"CDM"},{"code":"0214","type":"RC"}],"standard_charges":[{"gross_charge":3310.79,"discounted_cash":3310.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV CONTRAST ISOVUE 300/100 ML","code_information":[{"code":"255Q996701","type":"CDM"},{"code":"0255","type":"RC"},{"code":"Q9967","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.83,"discounted_cash":5.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF HYDRATION, 30-60 MIN","code_information":[{"code":"2609636001","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96360","type":"HCPCS"}],"standard_charges":[{"gross_charge":833.76,"discounted_cash":833.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF HYDRATION, EA ADDL HR","code_information":[{"code":"2609636101","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96361","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.32,"discounted_cash":279.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, INITIAL, TO 1 HR","code_information":[{"code":"2609636501","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96365","type":"HCPCS"}],"standard_charges":[{"gross_charge":991.58,"discounted_cash":991.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, EA ADD HOUR","code_information":[{"code":"2609636601","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96366","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.32,"discounted_cash":279.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, SEQUENTIAL, NEW DRUG, TO 1 HR","code_information":[{"code":"2609636701","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96367","type":"HCPCS"}],"standard_charges":[{"gross_charge":344.13,"discounted_cash":344.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF NON-CHEMO, THER/PROPH/DIAG, CONCURRENT","code_information":[{"code":"2609636801","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96368","type":"HCPCS"}],"standard_charges":[{"gross_charge":590.68,"discounted_cash":590.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, SUBQ/IM","code_information":[{"code":"2609637201","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96372","type":"HCPCS"}],"standard_charges":[{"gross_charge":187.66,"discounted_cash":187.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, IV PUSH, SGL/INITIAL DRUG","code_information":[{"code":"2609637401","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96374","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.7,"discounted_cash":413.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, EA IV PUSH, SEQUENTIAL, NEW DRUG","code_information":[{"code":"2609637501","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96375","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.93,"discounted_cash":191.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ NON-CHEMO, THER/PROPH/DIAG, EA IV PUSH, SEQUENTIAL, SAME DRUG","code_information":[{"code":"2609637601","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96376","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.93,"discounted_cash":191.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IRRIG IMPLANTED DRUG DELIVERY DEVICE","code_information":[{"code":"2609652301","type":"CDM"},{"code":"0260","type":"RC"},{"code":"96523","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.19,"discounted_cash":404.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY PS1753273 PICC DBL 5FR","code_information":[{"code":"272C175104","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":2668.01,"discounted_cash":2668.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY PS1790314 PICC TRPL 5FR","code_information":[{"code":"272C175105","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":3779.64,"discounted_cash":3779.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY PS1806966 POWERGLIDE MIDLINE 18G 8CM","code_information":[{"code":"272C175106","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4445.28,"discounted_cash":4445.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY PS1817234 POWERGLIDE MIDLINE 20G 8CM","code_information":[{"code":"272C175107","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":12607.48,"discounted_cash":12607.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY PS1817236 POWERGLIDE MIDLINE 18G 8CM","code_information":[{"code":"272C175109","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":12607.48,"discounted_cash":12607.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY PS1828844 POWERGLIDE MIDLINE 18G 8CM","code_information":[{"code":"272C175113","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4574.93,"discounted_cash":4574.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY PS1829511 POWERGLIDE MIDLINE 20G 8CM","code_information":[{"code":"272C175114","type":"CDM"},{"code":"0272","type":"RC"},{"code":"C1751","type":"HCPCS"}],"standard_charges":[{"gross_charge":4574.93,"discounted_cash":4574.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 274 SHELL CODE W/ HCPCS SURGICAL BOOT/SHOE, EACH","code_information":[{"code":"274L326001","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3260","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.84,"discounted_cash":90.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY ELBOW WRIST HAND ORTHOSIS, RIGID, W/O JNTS - L3763","code_information":[{"code":"274L376302","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.34,"discounted_cash":1996.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY WRIST HAND FINGER ORTHOSIS, RIGID W/O JNTS - L3808","code_information":[{"code":"274L380802","type":"CDM"},{"code":"0274","type":"RC"},{"code":"L3808","type":"HCPCS"}],"standard_charges":[{"gross_charge":1026.48,"discounted_cash":1026.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 25 SC) INTEGRA BMWD PER SQ CM","code_information":[{"code":"278Q410402","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.52,"discounted_cash":1756.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 125 SC) INTEGRA BMWD PER SQ CM","code_information":[{"code":"278Q410403","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.52,"discounted_cash":1756.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 250 SC) INTEGRA BMWD PER SQ CM","code_information":[{"code":"278Q410404","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.52,"discounted_cash":1756.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 258 SC) INTEGRA BMWD PER SQ CM","code_information":[{"code":"278Q410405","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4104","type":"HCPCS"}],"standard_charges":[{"gross_charge":1756.52,"discounted_cash":1756.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 32 SC) GRAFTJACKET PER SQ CM","code_information":[{"code":"278Q410708","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4107","type":"HCPCS"}],"standard_charges":[{"gross_charge":761.04,"discounted_cash":761.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 125 SC) INTEGRA MATRIX PER SQ CM","code_information":[{"code":"278Q410804","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4108","type":"HCPCS"}],"standard_charges":[{"gross_charge":1489.11,"discounted_cash":1489.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 130 SC) INTEGRA MATRIX PER SQ CM","code_information":[{"code":"278Q410806","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4108","type":"HCPCS"}],"standard_charges":[{"gross_charge":1489.11,"discounted_cash":1489.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 28 SC) ARTHROFLEX PER SQ CM","code_information":[{"code":"278Q412505","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4125","type":"HCPCS"}],"standard_charges":[{"gross_charge":715.96,"discounted_cash":715.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 8 SC) GRAFIX PRIME/GRAFIXPL PRIME/STRAVIX/STRAVIXPL PER SQ CM","code_information":[{"code":"278Q413307","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.35,"discounted_cash":1110.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 12 SC) GRAFIX PRIME/GRAFIXPL PRIME/STRAVIX/STRAVIXPL PER SQ CM","code_information":[{"code":"278Q413309","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.35,"discounted_cash":1110.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 18 SC) GRAFIX PRIME/GRAFIXPL PRIME/STRAVIX/STRAVIXPL PER SQ CM","code_information":[{"code":"278Q413310","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.35,"discounted_cash":1110.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 25 SC) GRAFIX PRIME/GRAFIXPL PRIME/STRAVIX/STRAVIXPL PER SQ CM","code_information":[{"code":"278Q413311","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4133","type":"HCPCS"}],"standard_charges":[{"gross_charge":1110.35,"discounted_cash":1110.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 21 SC) KERECIS OMEGA3 PER SQ CM","code_information":[{"code":"278Q415807","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.41,"discounted_cash":514.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 70 SC) KERECIS OMEGA3 PER SQ CM","code_information":[{"code":"278Q415811","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.41,"discounted_cash":514.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPPLY CHARGE SKIN SUB (TOT SZ 140 SC) KERECIS OMEGA3 PER SQ CM","code_information":[{"code":"278Q415812","type":"CDM"},{"code":"0278","type":"RC"},{"code":"Q4158","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.41,"discounted_cash":514.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD CULT ORG ID 6 OR GREATER TARGETS RRNA FISH","code_information":[{"code":"3000086U01","type":"CDM"},{"code":"0300","type":"RC"},{"code":"0086U","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.99,"discounted_cash":491.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHG COLLECTION VENOUS BLOOD,VENIPUNCTURE - DRAW CHARGE","code_information":[{"code":"3003641501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36415","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.39,"discounted_cash":34.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHG COLLECTION CAPILLARY BLOOD SPECIMEN - DRAW CHARGE","code_information":[{"code":"3003641601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36416","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.12,"discounted_cash":18.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COLLECT BLOOD FROM IMPLANT VENOUS ACCESS DEVICE","code_information":[{"code":"3003659101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36591","type":"HCPCS"}],"standard_charges":[{"gross_charge":200.55,"discounted_cash":200.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COLLECT BLOOD FROM CATHETER VENOUS NOS","code_information":[{"code":"3003659201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36592","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.07,"discounted_cash":163.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WITHDRAWAL OF ARTERIAL BLOOD","code_information":[{"code":"3003660001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"36600","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.95,"discounted_cash":125.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - BRCA1 VARIANTS","code_information":[{"code":"3008116201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81162","type":"HCPCS"}],"standard_charges":[{"gross_charge":4239.97,"discounted_cash":4239.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - ABL1 VARIANTS","code_information":[{"code":"3008117001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81170","type":"HCPCS"}],"standard_charges":[{"gross_charge":25212.56,"discounted_cash":25212.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - BCR/ABL1 MAJOR BREAK","code_information":[{"code":"3008120601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.4,"discounted_cash":569.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - BCR/ABL1 OTHER BREAK","code_information":[{"code":"3008120801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":486.1,"discounted_cash":486.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - BRAF V600E MUTATION","code_information":[{"code":"3008121001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81210","type":"HCPCS"}],"standard_charges":[{"gross_charge":571.69,"discounted_cash":571.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - CALR EXON 9 VARIANT","code_information":[{"code":"3008121901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.31,"discounted_cash":472.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALRETICULIN (CALR) MUTATION ANALYSIS (CSI) - ARUP","code_information":[{"code":"3008121902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":472.31,"discounted_cash":472.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CFTR GENE ANALYSIS COMMON VARIANTS - CYSTIC FIBROSIS DIAGNOSTIC STDY","code_information":[{"code":"3008122001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1691.38,"discounted_cash":1691.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - SNP VARIANTS","code_information":[{"code":"3008122901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81229","type":"HCPCS"}],"standard_charges":[{"gross_charge":2031.92,"discounted_cash":2031.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC F2 GENE ANALYSIS 20210G >A VARIANT - PROTHROMBIN GENE MUTATION","code_information":[{"code":"3008124001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.13,"discounted_cash":228.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 2 GENE MUTATION","code_information":[{"code":"3008124002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81240","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.13,"discounted_cash":228.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC F5 COAGULATION FACTOR V ANAL LEIDEN VARIANT - FACTOR V LEIDEN","code_information":[{"code":"3008124101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.81,"discounted_cash":254.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FMR1 (FRAG X DNA) WITH REFLEX TO METHYLATION ANALYSIS - ARUP","code_information":[{"code":"3008124303","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81243","type":"HCPCS"}],"standard_charges":[{"gross_charge":198.09,"discounted_cash":198.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HFE HEMOCHROMATOSIS GENE ANAL COMMON VARIANTS - HEMOCHROMATOSIS MUT","code_information":[{"code":"3008125601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.98,"discounted_cash":226.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - JAK2 V617F VARIANT","code_information":[{"code":"3008127001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":746.42,"discounted_cash":746.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MTHFR MUTATION PCR","code_information":[{"code":"3008129101","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81291","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.97,"discounted_cash":247.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TPMT VARIANTS - TPMT AND NUDT15 GENETICS - ARUP","code_information":[{"code":"3008133501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81335","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.35,"discounted_cash":838.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - TRB VARIANTS","code_information":[{"code":"3008134001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81340","type":"HCPCS"}],"standard_charges":[{"gross_charge":725.56,"discounted_cash":725.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENE ANALYSIS - TRG T CELL VARIANTS","code_information":[{"code":"3008134201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81342","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.79,"discounted_cash":699.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA TYPING MISCELLANEOUS","code_information":[{"code":"3008137202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81372","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.99,"discounted_cash":1167.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA PLATELET TYPING","code_information":[{"code":"3008137203","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81372","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.99,"discounted_cash":1167.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA TYPING - B27","code_information":[{"code":"3008137401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.88,"discounted_cash":225.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA TYPING - CLASS II DRB1 DRB3 DQB1 DQA1 DPB1 DPA12","code_information":[{"code":"3008138201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81382","type":"HCPCS"}],"standard_charges":[{"gross_charge":429.52,"discounted_cash":429.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA-1-ANTITRYPSIN PHENOTYPE","code_information":[{"code":"3008210401","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.96,"discounted_cash":39.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD GAS - ABG W 02 SAT","code_information":[{"code":"3008280501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"82805","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.15,"discounted_cash":458.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RBC ANTIBODY SCREEN - ANTIBODY SCREEN","code_information":[{"code":"3008685001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86850","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.76,"discounted_cash":110.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RBC ANTIBODY ELUTION - ELUTION & ANTIBODY IDENTIFICATION, RBC","code_information":[{"code":"3008686001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86860","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.22,"discounted_cash":192.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RBC ANTIBODY IDENTIFICATION - ANTIBODY IDENTIFICATION","code_information":[{"code":"3008687001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86870","type":"HCPCS"}],"standard_charges":[{"gross_charge":735.09,"discounted_cash":735.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIRECT COOMBS (ANTIGLOBULIN TEST)","code_information":[{"code":"3008688002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86880","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.85,"discounted_cash":112.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTIHUMAN GLOBULIN INDIRECT EA ANTIBODY TITER - ANTIBODY TITER","code_information":[{"code":"3008688601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86886","type":"HCPCS"}],"standard_charges":[{"gross_charge":148.24,"discounted_cash":148.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD TYPING SEROLOGIC ABO - ABO/RH TYPE","code_information":[{"code":"3008690002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86900","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.11,"discounted_cash":124.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD TYPING SEROLOGIC RH (D) - BLOOD TYPE","code_information":[{"code":"3008690102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86901","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.12,"discounted_cash":96.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EACH - BLOOD TYPING, ANTIGEN","code_information":[{"code":"3008690201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.28,"discounted_cash":73.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD TYPE ANTIGEN DONOR REAGENT SERUM EA - BLOOD TYPING,  ANTIGEN REFRD","code_information":[{"code":"3008690202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86902","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.38,"discounted_cash":18.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD TYPING RBC ANTIGENS OTH/THN ABO/RH D EACH - BLOOD TYPING, RBC","code_information":[{"code":"3008690501","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.95,"discounted_cash":74.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATIENT RBC PHENOTYPE REFERRED","code_information":[{"code":"3008690502","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86905","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.95,"discounted_cash":74.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD TYPING - RH PHENOTYPE COMPLETE","code_information":[{"code":"3008690601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86906","type":"HCPCS"}],"standard_charges":[{"gross_charge":291.98,"discounted_cash":291.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CROSSMATCH - IMMEDIATE SPIN","code_information":[{"code":"3008692001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86920","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.47,"discounted_cash":151.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CROSSMATCH - ANTIHUMAN GLOBULIN","code_information":[{"code":"3008692201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.42,"discounted_cash":372.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CROSSMATCH - ANTIHUMAN GLOBULIN REF LAB","code_information":[{"code":"3008692202","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86922","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.42,"discounted_cash":372.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD COMPATIBILITY - CROSSMATCH -COMPUTER","code_information":[{"code":"3008692301","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86923","type":"HCPCS"}],"standard_charges":[{"gross_charge":372.42,"discounted_cash":372.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT","code_information":[{"code":"3008697001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86970","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT SEPARATION","code_information":[{"code":"3008697201","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86972","type":"HCPCS"}],"standard_charges":[{"gross_charge":239.44,"discounted_cash":239.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD COMPATIBILITY ANTIBODY IDENTIFICATION - PRETREATMENT ABSORPTION","code_information":[{"code":"3008697801","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86978","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MONOCYTE MONOLAYER ASSAY (MMA) - ONEBLOOD","code_information":[{"code":"3008699902","type":"CDM"},{"code":"0300","type":"RC"},{"code":"86999","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.01,"discounted_cash":215.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - O&P STAIN","code_information":[{"code":"3008720901","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.32,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SARS-COV2 + INFLUENZA A AND B PCR MULTIPLEX","code_information":[{"code":"3008763601","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.58,"discounted_cash":473.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SARS-COV2 + INFLUENZA A AND B + RSV PCR MULTIPLEX","code_information":[{"code":"3008763701","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.56,"discounted_cash":468.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COVID-19, FLU A, FLU B, RSV PCR","code_information":[{"code":"3008763702","type":"CDM"},{"code":"0300","type":"RC"},{"code":"87637","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.56,"discounted_cash":468.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CELL COUNT,MISC BODY FLUIDS - BODY FLUID CELL COUNT","code_information":[{"code":"3008905001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89050","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.82,"discounted_cash":261.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BODY FLUID CELL COUNT W DIFF - BODY FLUID CELL COUNT W/DIFF","code_information":[{"code":"3008905102","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89051","type":"HCPCS"}],"standard_charges":[{"gross_charge":229.96,"discounted_cash":229.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CRYSTALS, BODY FLUID","code_information":[{"code":"3008906002","type":"CDM"},{"code":"0300","type":"RC"},{"code":"89060","type":"HCPCS"}],"standard_charges":[{"gross_charge":217.41,"discounted_cash":217.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELET PATHOGEN TESTING PER UNIT","code_information":[{"code":"300P910001","type":"CDM"},{"code":"0300","type":"RC"},{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.79,"discounted_cash":149.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BASIC METABOLIC PANEL CALCIUM IONIZED","code_information":[{"code":"3018004701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80047","type":"HCPCS"}],"standard_charges":[{"gross_charge":235.81,"discounted_cash":235.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BASIC METABOLIC PANEL CALCIUM TOTAL","code_information":[{"code":"3018004801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80048","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.88,"discounted_cash":289.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENERAL HEALTH PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80050","type":"HCPCS"}],"standard_charges":[{"gross_charge":793.29,"discounted_cash":793.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ELECTROLYTE PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80051","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.54,"discounted_cash":177.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COMPREHENSIVE METABOLIC PANEL - CMP","code_information":[{"code":"3018005301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80053","type":"HCPCS"}],"standard_charges":[{"gross_charge":483.81,"discounted_cash":483.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSTETRIC PANEL - BUNDLED CHARGE","code_information":[{"code":"3018005501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80055","type":"HCPCS"}],"standard_charges":[{"gross_charge":739.53,"discounted_cash":739.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPID PANEL - BUNDLED CHARGE","code_information":[{"code":"3018006101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.17,"discounted_cash":327.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPID PROFILE BY NMR - NMR LIPOMED PROFILE - ARUP","code_information":[{"code":"3018006102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":327.17,"discounted_cash":327.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPID PROFILE CARDIO IQ","code_information":[{"code":"3018006103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.76,"discounted_cash":38.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPID PANEL - CARDIO IQ - QWDL","code_information":[{"code":"3018006104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80061","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.76,"discounted_cash":38.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RENAL FUNCTION PANEL - BUNDLED CHARGE","code_information":[{"code":"3018006901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80069","type":"HCPCS"}],"standard_charges":[{"gross_charge":422.44,"discounted_cash":422.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS PANEL,ACUTE - BUNDLED CHARGE","code_information":[{"code":"3018007401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80074","type":"HCPCS"}],"standard_charges":[{"gross_charge":278.33,"discounted_cash":278.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATIC FUNCTION PANEL - BUNDLED CHARGE","code_information":[{"code":"3018007601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80076","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.23,"discounted_cash":227.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETAMINOPHEN (TYLENOL) LEVEL","code_information":[{"code":"3018014301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80143","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.74,"discounted_cash":64.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY - ADALIMUMAB - ARUP","code_information":[{"code":"3018014502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80145","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.75,"discounted_cash":368.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMIKACIN LEVEL","code_information":[{"code":"3018015001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80150","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.83,"discounted_cash":45.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMIODARONE LEVEL","code_information":[{"code":"3018015101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80151","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.95,"discounted_cash":53.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CARBAMAZEPINE TOTAL - CARBAMAZEPINE TOTAL","code_information":[{"code":"3018015601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.45,"discounted_cash":290.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARBAMAZEPINE LEVEL TOTAL - CARBAMAZEPINE FREE AND TOTAL - ARUP","code_information":[{"code":"3018015602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80156","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.45,"discounted_cash":290.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ASSAY CARBAMAZEPINE, FREE - CARBAMAZEPINE FREE","code_information":[{"code":"3018015701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.14,"discounted_cash":176.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARBAMAZEPINE LEVEL FREE - CARBAMAZEPINE FREE AND TOTAL -ARUP","code_information":[{"code":"3018015702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80157","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.14,"discounted_cash":176.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CYCLOSPORINE - CYCLOSPORINE","code_information":[{"code":"3018015801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80158","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.86,"discounted_cash":54.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIGOXIN LEVEL TOTAL","code_information":[{"code":"3018016201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80162","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.24,"discounted_cash":173.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VALPROIC ACID LEVEL TOTAL","code_information":[{"code":"3018016402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.96,"discounted_cash":140.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VALPROIC ACID TOTAL - VALPROIC ACID FREE AND TOTAL - ARUP","code_information":[{"code":"3018016405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80164","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.97,"discounted_cash":43.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VALPROIC ACID LEVEL FREE ARUP","code_information":[{"code":"3018016501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.19,"discounted_cash":39.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VALPROIC ACID FREE - VALPROIC ACID FREE AND TOTAL - ARUP","code_information":[{"code":"3018016502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80165","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.19,"discounted_cash":39.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ETHOSUXIMIDE - ETHOSUXIMIDE LEVEL","code_information":[{"code":"3018016801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.64,"discounted_cash":49.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ETHOSUXIMIDE LEVEL - ARUP","code_information":[{"code":"3018016802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80168","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.64,"discounted_cash":49.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EVEROLIMUS (AFINITOR) LEVEL - ARUP","code_information":[{"code":"3018016902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80169","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.0,"discounted_cash":125.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF GENTAMICIN - GENTAMICIN RANDOM","code_information":[{"code":"3018017002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80170","type":"HCPCS"}],"standard_charges":[{"gross_charge":286.47,"discounted_cash":286.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF DRUG - LAMOTRIGINE/LAMICTAL LEVEL","code_information":[{"code":"3018017501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.84,"discounted_cash":30.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAMOTRIGINE (LAMICTAL) LEVEL - ARUP","code_information":[{"code":"3018017502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80175","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.84,"discounted_cash":30.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIDOCAINE LEVEL - ARUP","code_information":[{"code":"3018017602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80176","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.66,"discounted_cash":44.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEVETIRACETAM (KEPPRA) LEVEL","code_information":[{"code":"3018017701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80177","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.04,"discounted_cash":62.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LITHIUM LEVEL","code_information":[{"code":"3018017801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80178","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.76,"discounted_cash":164.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG THERAPEUTIC LEVEL - SALICYLATE LEVEL SERUM","code_information":[{"code":"3018017901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80179","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.72,"discounted_cash":265.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY - MYCOPHENOLIC ACID","code_information":[{"code":"3018018001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80180","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.44,"discounted_cash":43.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF DRUG - OXCARBAZEPINE/TRILEPTAL LEVEL","code_information":[{"code":"3018018301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.77,"discounted_cash":34.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OXCARBAZEPINE (TRILEPTAL) LEVEL - ARUP","code_information":[{"code":"3018018302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80183","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.77,"discounted_cash":34.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHENOBARBITAL LEVEL","code_information":[{"code":"3018018401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.45,"discounted_cash":290.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHENOBARBITAL LEVEL - ARUP","code_information":[{"code":"3018018402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.65,"discounted_cash":184.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHENOBARBITAL LEVEL - PRIMIDONE AND METABOLITE - ARUP","code_information":[{"code":"3018018403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80184","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.65,"discounted_cash":184.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHENYTOIN LEVEL TOTAL","code_information":[{"code":"3018018502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.95,"discounted_cash":157.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHENYTOIN LEVEL TOTAL - ARUP","code_information":[{"code":"3018018504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80185","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.95,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHENYTOIN LEVEL FREE","code_information":[{"code":"3018018601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.19,"discounted_cash":42.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHENYTOIN LEVEL FREE - ARUP","code_information":[{"code":"3018018603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80186","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.95,"discounted_cash":40.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRIMIDONE LEVEL - ARUP","code_information":[{"code":"3018018801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRIMIDONE LEVEL - PRIMIDONE AND METABOLITE - ARUP","code_information":[{"code":"3018018802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80188","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ITRACONAZOLE LEVEL","code_information":[{"code":"3018018901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80189","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.47,"discounted_cash":78.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SIROLIMUS LEVEL","code_information":[{"code":"3018019501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80195","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.79,"discounted_cash":69.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TACROLIMUS LEVEL IMMUNOASSAY","code_information":[{"code":"3018019701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80197","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.87,"discounted_cash":48.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THEOPHYLLINE LEVEL","code_information":[{"code":"3018019801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80198","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.02,"discounted_cash":304.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOBRAMYCIN LEVEL","code_information":[{"code":"3018020002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80200","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.31,"discounted_cash":71.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF TOPIRAMATE - TOPIRAMATE LEVEL","code_information":[{"code":"3018020101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.26,"discounted_cash":61.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOPIRAMATE LEVEL - ARUP","code_information":[{"code":"3018020102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80201","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.26,"discounted_cash":61.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VANCOMYCIN LEVEL","code_information":[{"code":"3018020202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80202","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.72,"discounted_cash":244.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY - ZONISAMIDE","code_information":[{"code":"3018020301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.2,"discounted_cash":78.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ZONISAMIDE LEVEL- ARUP","code_information":[{"code":"3018020302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80203","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.2,"discounted_cash":78.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG THERAPEUTIC LEVEL - METHOTREXATE LEVEL","code_information":[{"code":"3018020401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80204","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.96,"discounted_cash":133.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY - INFLIXIMAB","code_information":[{"code":"3018023001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":497.9,"discounted_cash":497.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY - INFLIXIMAB - ARUP","code_information":[{"code":"3018023002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80230","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.75,"discounted_cash":368.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THERAPEUTIC DRUG ASSAY - LACOSAMIDE LEVEL","code_information":[{"code":"3018023501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.15,"discounted_cash":94.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LACOSAMIDE LEVEL - ARUP","code_information":[{"code":"3018023502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80235","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.15,"discounted_cash":94.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY VEDOLIZUMAB","code_information":[{"code":"3018028001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80280","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.31,"discounted_cash":106.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY - VORICONAZOLE","code_information":[{"code":"3018028501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80285","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.2,"discounted_cash":83.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF DRUG - THIOPURINE METABOLITES LEVEL","code_information":[{"code":"3018029919","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":398.92,"discounted_cash":398.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY - DEXAMETHASONE","code_information":[{"code":"3018029922","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.65,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG ASSAY - USTEKINUMAB","code_information":[{"code":"3018029933","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.74,"discounted_cash":64.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DEXAMETHASONE LEVEL - ARUP","code_information":[{"code":"3018029935","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80299","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.65,"discounted_cash":56.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG TEST PRSMV DIR OPT OBS - TOXICOLOGY SCREEN URINE","code_information":[{"code":"3018030505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80305","type":"HCPCS"}],"standard_charges":[{"gross_charge":861.97,"discounted_cash":861.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BENZODIAZEPINE LEVEL URINE QUAL","code_information":[{"code":"3018030702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1049.92,"discounted_cash":1049.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN 9 TARGETS WITH CONFIRMATION/QUANTITATION URINE - ARUP","code_information":[{"code":"3018030730","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.75,"discounted_cash":69.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL URINE","code_information":[{"code":"3018030732","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.12,"discounted_cash":1370.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE 9 AND CONFIRM","code_information":[{"code":"3018030734","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.12,"discounted_cash":1370.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL COMPREHENSIVE 7 AND CONFIRM","code_information":[{"code":"3018030735","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.12,"discounted_cash":1370.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOXICOLOGY SCREEN URINE, 10 DRUG CLASSES","code_information":[{"code":"3018030736","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.12,"discounted_cash":1370.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG TEST PRSMV CHEM ANLYZR - DRUG SCREEN PANEL SERUM AND CONFIRM","code_information":[{"code":"3018030737","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.12,"discounted_cash":1370.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URINE DRUG SCREEN WITH CONFIRMATION","code_information":[{"code":"3018030754","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.12,"discounted_cash":1370.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URINE FENTANYL SCREEN","code_information":[{"code":"3018030760","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.84,"discounted_cash":179.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN 7 WITH REFLEX CONFIRMATION URINE - ARUP","code_information":[{"code":"3018030764","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.25,"discounted_cash":62.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN 9 WITH REFLEX CONFIRMATION URINE - ARUP","code_information":[{"code":"3018030765","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.12,"discounted_cash":1370.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DOA ALCOHOL URINE SCREEN WITH REFLEX TO CONFIRM - ARUP","code_information":[{"code":"3018030766","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.04,"discounted_cash":272.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN PANEL 9 WITH REFLEX CONFIRMATION SERUM OR PLASMA - ARUP","code_information":[{"code":"3018030767","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.12,"discounted_cash":1370.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COTININE LEVEL URINE - ARUP","code_information":[{"code":"3018030772","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80307","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.69,"discounted_cash":53.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ETHANOL URINE","code_information":[{"code":"3018032001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.04,"discounted_cash":90.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ALCOHOLS","code_information":[{"code":"3018032005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.67,"discounted_cash":41.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - ISOPROPANOL","code_information":[{"code":"3018032006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.04,"discounted_cash":90.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN QUANTITATIVE ALCOHOLS - METHANOL","code_information":[{"code":"3018032007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.04,"discounted_cash":90.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ISOPROPYL ALCOHOL LEVEL - ARUP","code_information":[{"code":"3018032008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.0,"discounted_cash":56.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC METHANOL LEVEL - ARUP","code_information":[{"code":"3018032009","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80320","type":"HCPCS"}],"standard_charges":[{"gross_charge":90.04,"discounted_cash":90.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG TEST DEFIN - ALCOHOL BIOMARKERS","code_information":[{"code":"3018032101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.39,"discounted_cash":221.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHOSPHATIDYLETHANOL (PETH) - ARUP","code_information":[{"code":"3018032104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.39,"discounted_cash":221.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ETHYL GLUCURONIDE, CORDTISS, QUAL - ARUP","code_information":[{"code":"3018032105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80321","type":"HCPCS"}],"standard_charges":[{"gross_charge":221.39,"discounted_cash":221.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NICOTINE AND METABOLITES QUANT - ARUP","code_information":[{"code":"3018032306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.09,"discounted_cash":179.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NICOTINE AND METABOLITES URINE - ARUP","code_information":[{"code":"3018032309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.09,"discounted_cash":179.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NICOTINE AND METABOLITES PLASMA - ARUP","code_information":[{"code":"3018032310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80323","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.09,"discounted_cash":179.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREEN QUANT AMPHETAMINES 1 OR 2 - AMPHETAMINE, BLOOD, QUANT","code_information":[{"code":"3018032401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80324","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.76,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMPHETAMINE QUANT - AMPHETAMINE URINE CONFIRMATION - ARUP","code_information":[{"code":"3018032502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80325","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.47,"discounted_cash":56.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMITRIPTYLINE AND NORTRIPTYLINE SP LEVEL - ARUP","code_information":[{"code":"3018033518","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80335","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.77,"discounted_cash":34.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTIDEP TRICYCLIC/CYCLICALS 6+ TRICYCLIC ANTIDEP - BUNDLED CHARGE","code_information":[{"code":"3018033701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80337","type":"HCPCS"}],"standard_charges":[{"gross_charge":177.41,"discounted_cash":177.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTIEPILEPTICS NOS 1-3 RUFINAMIDE - BUNDLED CHARGE","code_information":[{"code":"3018033909","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.05,"discounted_cash":304.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COBAZAM (ONFI) LEVEL - ARUP","code_information":[{"code":"3018033910","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80339","type":"HCPCS"}],"standard_charges":[{"gross_charge":304.05,"discounted_cash":304.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARIPIPRAZOLE LEVEL AND METABOLITE (ABILIFY) SERUM OR PLASMA - ARUP","code_information":[{"code":"3018034224","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80342","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.61,"discounted_cash":136.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING BARBITURATES - BARBITURATE URINE QUANT","code_information":[{"code":"3018034501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.47,"discounted_cash":56.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARBITURATE URINE CONFIRMATION - ARUP","code_information":[{"code":"3018034506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.47,"discounted_cash":56.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARBITURATES BLOOD QUANT - ARUP","code_information":[{"code":"3018034507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80345","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.47,"discounted_cash":56.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 BENZODIAZEPINE - BUNDLED CHARGE","code_information":[{"code":"3018034604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.18,"discounted_cash":142.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 - ALPRAZOLAM / XANAX URINE QUANT","code_information":[{"code":"3018034607","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":265.28,"discounted_cash":265.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 - BENZODIAZEPINE MECONIUM QUANT","code_information":[{"code":"3018034608","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.89,"discounted_cash":170.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING BENZODIAZEPINES 1-12 - CLONAZEPAM / KLONOPIN QUANT","code_information":[{"code":"3018034610","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.7,"discounted_cash":41.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BENZODIAZEPINE LEVEL URINE QUANT - ARUP","code_information":[{"code":"3018034615","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.21,"discounted_cash":127.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLONAZEPAM LEVEL - ARUP","code_information":[{"code":"3018034616","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.7,"discounted_cash":41.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BENZODIAZEPINE LEVEL QUANT SERUM OR PLASMA - ARUP","code_information":[{"code":"3018034618","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80346","type":"HCPCS"}],"standard_charges":[{"gross_charge":142.18,"discounted_cash":142.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING BUPRENORPHINE","code_information":[{"code":"3018034801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BUPRENORPHINE LEVEL & METABOLITES QUANT SERUM OR PLASMA - ARUP","code_information":[{"code":"3018034805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80348","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION UR","code_information":[{"code":"3018034901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.3,"discounted_cash":106.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING CANNABINOIDS NATURAL - CANNABINOID CONFIRMATION","code_information":[{"code":"3018034902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THC (CANNABINOID) METABOLITE QUANT URINE - ARUP","code_information":[{"code":"3018034906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.3,"discounted_cash":106.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THC (CANNABINOID) CONFIRMATION SERUM OR PLASMA - ARUP","code_information":[{"code":"3018034907","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80349","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING COCAINE - COCAINE URINE CONF","code_information":[{"code":"3018035301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.74,"discounted_cash":91.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING COCAINE - COCAINE MECONIUM CONF","code_information":[{"code":"3018035303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COCAINE BLOOD QUANT - ARUP","code_information":[{"code":"3018035304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80353","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING FENTANYL - FENTANYL URINE","code_information":[{"code":"3018035401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.03,"discounted_cash":119.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING FENTANYL - FENTANYL","code_information":[{"code":"3018035402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80354","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.52,"discounted_cash":152.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING METHADONE - METHADONE & METABOLITE LEVEL","code_information":[{"code":"3018035801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80358","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.84,"discounted_cash":132.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING METHYLENEDIOXYAMPHETAMINES","code_information":[{"code":"3018035902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.09,"discounted_cash":179.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC METHAMPHETAMINE QUANT - AMPHETAMINE URINE CONFIRMATION - ARUP","code_information":[{"code":"3018035903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80359","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.09,"discounted_cash":179.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE - OPIATE,QUANTITATIVE,UR CONF","code_information":[{"code":"3018036101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.76,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING OPIATES 1 OR MORE - BUNDLED CHARGE","code_information":[{"code":"3018036102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.14,"discounted_cash":121.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OPIATE LEVEL QUANT URINE CONFIRMATION - ARUP","code_information":[{"code":"3018036104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80361","type":"HCPCS"}],"standard_charges":[{"gross_charge":137.76,"discounted_cash":137.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG SCREENING OXYCODONE - CONFIRMATION","code_information":[{"code":"3018036501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80365","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRAMADOL LEVEL URINE","code_information":[{"code":"3018037301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80373","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.5,"discounted_cash":153.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - METFORMIN LEVEL","code_information":[{"code":"3018037505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.24,"discounted_cash":292.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRUG/SUBSTANCE DEFINITIVE QUAL/QUANT NOS 1-3 - BUNDLED CHARGE","code_information":[{"code":"3018037506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80375","type":"HCPCS"}],"standard_charges":[{"gross_charge":292.24,"discounted_cash":292.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HYPOGLYCEMIA PANEL (SULFONYLUREAS), SERUM OR PLASMA - ARUP","code_information":[{"code":"3018037705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"80377","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.78,"discounted_cash":284.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA GLOBIN HBA2 SEQUENCING AND DELETION","code_information":[{"code":"3018126901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81269","type":"HCPCS"}],"standard_charges":[{"gross_charge":1012.52,"discounted_cash":1012.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIAL VAGINOSIS RNA MARKERS QUALITATIVE","code_information":[{"code":"3018151301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"81513","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.04,"discounted_cash":59.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC KETONE BODIES SERUM QUANTITATIVE - BETA HYDROXYBUTYRATE","code_information":[{"code":"3018201002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82010","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.23,"discounted_cash":70.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ACTH - ACTH","code_information":[{"code":"3018202401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.36,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACTH LEVEL","code_information":[{"code":"3018202402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82024","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.36,"discounted_cash":117.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN LEVEL","code_information":[{"code":"3018204001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.49,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN LEVEL SERUM -  IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018204003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.49,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN LEVEL ARUP OLIGOCLONAL BAND","code_information":[{"code":"3018204004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.49,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN LEVEL SERUM - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82040","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.49,"discounted_cash":86.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF URINE ALBUMIN - ALBUMIN BODY FLUID","code_information":[{"code":"3018204201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.58,"discounted_cash":65.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN CSF IGG SYNTH -ARUP","code_information":[{"code":"3018204203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.58,"discounted_cash":65.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN CSF IGG OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.58,"discounted_cash":65.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN BODY FLUID","code_information":[{"code":"3018204208","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.58,"discounted_cash":65.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN LEVEL CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018204210","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.58,"discounted_cash":65.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN LEVEL CSF - IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018204211","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82042","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.58,"discounted_cash":65.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN 24HR URINE","code_information":[{"code":"3018204301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.18,"discounted_cash":112.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN RANDOM URINE","code_information":[{"code":"3018204302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.18,"discounted_cash":112.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROALBUMIN, QUANTITATIVE - MICROALBUMIN / CREATININE URINE RATIO","code_information":[{"code":"3018204303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.61,"discounted_cash":73.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALBUMIN LEVEL - ALBUMIN / CREATININE RATIO URINE - ARUP","code_information":[{"code":"3018204305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.61,"discounted_cash":73.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROALBUMIN LEVEL -  MICROALBUMIN/CREATININE RATIO RANDOME URINE MG/DL","code_information":[{"code":"3018204306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.18,"discounted_cash":112.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROALBUMIN LEVEL - MICROALBUMIN/CREATININE RATIO RANDOM URINE MG/L","code_information":[{"code":"3018204307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82043","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.18,"discounted_cash":112.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ETHANOL LEVEL","code_information":[{"code":"3018207701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82077","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.82,"discounted_cash":339.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ALDOLASE - ALDOLASE","code_information":[{"code":"3018208501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.1,"discounted_cash":28.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALDOLASE LEVEL - ARUP","code_information":[{"code":"3018208502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82085","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.1,"discounted_cash":28.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALDOSTERONE LEVEL - ARUP","code_information":[{"code":"3018208802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.94,"discounted_cash":117.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALDOSTERONE LEVEL - ALDOSTERONE/RENIN ACTIVITY RATIO - ARUP","code_information":[{"code":"3018208803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALDOSTERONE 24 HOUR URINE - ARUP","code_information":[{"code":"3018208804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82088","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":23.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL","code_information":[{"code":"3018210301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.59,"discounted_cash":70.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA-1-ANTITRYPSIN TOTAL - A1A PHENOTYPE - ARUP","code_information":[{"code":"3018210307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82103","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.08,"discounted_cash":63.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA 1 ANTITRYPSIN PHENOTYPE - A1A PHENOTYPE - ARUP","code_information":[{"code":"3018210403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82104","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.96,"discounted_cash":39.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA FETOPROTEIN (AFP) TUMOR MARKER","code_information":[{"code":"3018210501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.1,"discounted_cash":181.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA FETOPROTEIN MATERNAL SERUM - ARUP","code_information":[{"code":"3018210502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82105","type":"HCPCS"}],"standard_charges":[{"gross_charge":181.1,"discounted_cash":181.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA-FETOPROTEIN L3 - ALPHA FETOPROTEIN, L3 PERCENT","code_information":[{"code":"3018210701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.03,"discounted_cash":335.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA FETOPROTEIN (AFP) TOTAL AND L3 PERCENT - ARUP","code_information":[{"code":"3018210702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82107","type":"HCPCS"}],"standard_charges":[{"gross_charge":335.03,"discounted_cash":335.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALUMINUM LEVEL - ARUP","code_information":[{"code":"3018210802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82108","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.39,"discounted_cash":17.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYSTINE URINE QUANTITATIVE ARUP","code_information":[{"code":"3018213111","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82131","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.81,"discounted_cash":79.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMINO ACIDS, 6+ QUANT - AMINO ACID QUANT,URINE","code_information":[{"code":"3018213901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.62,"discounted_cash":139.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMINO ACIDS 6+ QUANT - AMINO ACIDS CSF","code_information":[{"code":"3018213903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.72,"discounted_cash":201.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMINO ACIDS, 6+ QUANT PLASMA - ARUP","code_information":[{"code":"3018213906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82139","type":"HCPCS"}],"standard_charges":[{"gross_charge":139.62,"discounted_cash":139.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMMONIA LEVEL","code_information":[{"code":"3018214001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82140","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.36,"discounted_cash":329.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF AMYLASE - AMYLASE BODY FLUID","code_information":[{"code":"3018215001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.64,"discounted_cash":323.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMYLASE LEVEL","code_information":[{"code":"3018215005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.64,"discounted_cash":323.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMYLASE LEVEL, BODY FLUID - UCH","code_information":[{"code":"3018215011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82150","type":"HCPCS"}],"standard_charges":[{"gross_charge":323.64,"discounted_cash":323.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ANDROSTENEDIONE - ANDROSTENEDIONE","code_information":[{"code":"3018215701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.39,"discounted_cash":50.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANDROSTENEDIONE LEVEL - ARUP","code_information":[{"code":"3018215702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82157","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.39,"discounted_cash":50.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERTING ENZYME","code_information":[{"code":"3018216401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.46,"discounted_cash":23.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIOTENSIN I ENZYME TEST - ANGIOTENSIN CONVERT ENZYME CSF","code_information":[{"code":"3018216402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.34,"discounted_cash":22.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIOTENSIN CONVERT ENZYME CSF - ARUP","code_information":[{"code":"3018216403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82164","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.34,"discounted_cash":22.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI-MULLERIAN HORMONE (AMH) ASSAY","code_information":[{"code":"3018216601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82166","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF APOLIPOPROTEIN - LIPOPROTEIN A (LPA)","code_information":[{"code":"3018217201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APOLIPOPROTEIN B100","code_information":[{"code":"3018217202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APOLIPOPROTEIN A1 - ARUP","code_information":[{"code":"3018217205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APOLIPOPROTEIN B 100 - ARUP","code_information":[{"code":"3018217206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN A - CARDIO IQ - QWDL","code_information":[{"code":"3018217207","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82172","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ARSENIC - ARSENIC,FRACTIONATION,UR","code_information":[{"code":"3018217502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":87.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ARSENIC - ARSENIC RANDOM URINE","code_information":[{"code":"3018217503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.57,"discounted_cash":87.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARSENIC URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018217504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.48,"discounted_cash":195.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARSENIC LEVEL","code_information":[{"code":"3018217505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARSENIC LEVEL BLOOD - ARUP","code_information":[{"code":"3018217509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.88,"discounted_cash":28.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARSENIC URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018217510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82175","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.48,"discounted_cash":195.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ASCORBIC ACID - VITAMIN C","code_information":[{"code":"3018218001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.34,"discounted_cash":37.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN C (ASCORBIC ACID) LEVEL - ARUP","code_information":[{"code":"3018218002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82180","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.34,"discounted_cash":37.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BETA-2 PROTEIN - BETA 2 MICROGLOBULIN","code_information":[{"code":"3018223202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.82,"discounted_cash":46.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BETA 2 MICROGLOBULIN SERUM - ARUP","code_information":[{"code":"3018223205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82232","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.82,"discounted_cash":46.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BILE ACIDS, TOTAL - BILE ACIDS, TOTAL","code_information":[{"code":"3018223901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82239","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.54,"discounted_cash":19.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BILIRUBIN TOTAL - BILIRUBIN BODY FLUID","code_information":[{"code":"3018224702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.38,"discounted_cash":53.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BILIRUBIN TOTAL","code_information":[{"code":"3018224703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.38,"discounted_cash":53.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BILIRUBIN TOTAL - BILIRUBIN NEONATAL","code_information":[{"code":"3018224704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.28,"discounted_cash":228.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BILIRUBIN TOTAL BODY FLUID - ARUP","code_information":[{"code":"3018224708","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82247","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.38,"discounted_cash":53.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BILIRUBIN DIRECT","code_information":[{"code":"3018224801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82248","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.78,"discounted_cash":93.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD OCCULT,BY PEROXID,FECES,SINGLE, COLORECTAL SCREEN - OCCULT BLD","code_information":[{"code":"3018227001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82270","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.62,"discounted_cash":171.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCULT BLOOD GASTRIC / DUODENUM","code_information":[{"code":"3018227101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82271","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.62,"discounted_cash":41.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCULT BLOOD - OCCULT BLOOD STOOL","code_information":[{"code":"3018227201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.62,"discounted_cash":171.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POC FECAL OCCULT BLOOD STOOL","code_information":[{"code":"3018227202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82272","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.62,"discounted_cash":171.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCULT BLOOD - 1 TO 3 SIMULTANEOUS TESTS POC","code_information":[{"code":"3018227401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.87,"discounted_cash":131.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCULT BLOOD FECES SCREENING SPECIMEN #1","code_information":[{"code":"3018227402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.87,"discounted_cash":131.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCULT BLOOD BY IMMUNOASSAY, FECES","code_information":[{"code":"3018227404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82274","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.87,"discounted_cash":131.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CADMIUM LEVEL -  PANEL 4 BLOOD ARUP","code_information":[{"code":"3018230003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82300","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.59,"discounted_cash":38.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN D 25-HYDROXY LEVEL DEFICIENCY","code_information":[{"code":"3018230601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":165.74,"discounted_cash":165.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN D2 AND D3 25 HYDROXY LEVEL - ARUP","code_information":[{"code":"3018230602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82306","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CALCITONIN - CALCITONIN","code_information":[{"code":"3018230801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.77,"discounted_cash":34.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCITONIN - ARUP","code_information":[{"code":"3018230802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82308","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.77,"discounted_cash":34.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCIUM TOTAL LEVEL","code_information":[{"code":"3018231001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.85,"discounted_cash":47.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CALCIUM, TOTAL - POCT CALCIUM, TOTAL","code_information":[{"code":"3018231002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.29,"discounted_cash":77.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CALCIUM, TOTAL - ADDITIONAL CHARGE","code_information":[{"code":"3018231004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.85,"discounted_cash":47.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCIUM LEVEL TOTAL -  PTH INTACT WITH CALCIUM - ARUP","code_information":[{"code":"3018231006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82310","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.58,"discounted_cash":22.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CALCIUM, IONIZED - CALCIUM IONIZED","code_information":[{"code":"3018233001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82330","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.82,"discounted_cash":205.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCIUM RANDOM URINE","code_information":[{"code":"3018234001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCIUM TIMED URINE","code_information":[{"code":"3018234002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.08,"discounted_cash":21.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCIUM 24 HR URINE CALCULI RISK - ARUP","code_information":[{"code":"3018234003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.85,"discounted_cash":101.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCIUM SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018234005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCIUM RANDOM URINE - CALCIUM/CREATININE URINE RATIO","code_information":[{"code":"3018234006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.97,"discounted_cash":8.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCIUM - KIDNEY STONE RISK PANEL URINE - ARUP","code_information":[{"code":"3018234008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82340","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.08,"discounted_cash":21.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALCULUS ASSAY,INFRARED SPECTR - KIDNEY STONE ANALYSIS","code_information":[{"code":"3018236501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82365","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.69,"discounted_cash":35.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY CARBOHYDRATE DEF TRANSFERRIN - CARBOHYDRATE DEFICIENT TRANS","code_information":[{"code":"3018237301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.14,"discounted_cash":360.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARBOHYDRATE DEFICIENT TRANSFERRIN FOR ALCOHOL USE - ARUP","code_information":[{"code":"3018237302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82373","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.14,"discounted_cash":360.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CO2 TOTAL BLOOD","code_information":[{"code":"3018237401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY URINE CARBON DIOXIDE - CO2 TOTAL","code_information":[{"code":"3018237402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82374","type":"HCPCS"}],"standard_charges":[{"gross_charge":122.0,"discounted_cash":122.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY BLOOD CARBON MONOXIDE - CARBOXYHEMOGLOBIN","code_information":[{"code":"3018237501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.16,"discounted_cash":136.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARBOXYHEMOGLOBIN QUANT, CO-OX, WHOLE BLOOD - ARUP","code_information":[{"code":"3018237502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82375","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.16,"discounted_cash":136.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN (CEA)","code_information":[{"code":"3018237801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.36,"discounted_cash":191.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARCINOEMBRYONIC ANTIGEN (CEA) FLUID - ARUP","code_information":[{"code":"3018237805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82378","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.99,"discounted_cash":184.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CARNITINE - CARNITINE","code_information":[{"code":"3018237901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARNITINE TOTAL AND FREE - ARUP","code_information":[{"code":"3018237903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82379","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY, THREE CATECHOLAMINES - CATECHOLAMINES FRACTIONATED PL","code_information":[{"code":"3018238402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.04,"discounted_cash":46.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATECHOLAMINES, FRACTIONATED, BY LC-MS/MS - ARUP","code_information":[{"code":"3018238403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.04,"discounted_cash":46.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATECHOLAMINES, FRACTIONATED, PLASMA - ARUP","code_information":[{"code":"3018238405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82384","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.04,"discounted_cash":46.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CERULOPLASMIN - CERULOPLASMIN","code_information":[{"code":"3018239001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.03,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CERULOPLASMIN LEVEL","code_information":[{"code":"3018239002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82390","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.03,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHEMILUMINESCENT ASSAY - IGF BINDING PROTEIN 3","code_information":[{"code":"3018239702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":28.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHEMILUMINESCENT ASSAY - MISCELLANEOUS","code_information":[{"code":"3018239704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.82,"discounted_cash":94.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGF BINDING PROTEIN 3 - ARUP","code_information":[{"code":"3018239707","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.95,"discounted_cash":28.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHEMILUMINESCENT ASSAY - ANTIBODIES TO ADALIMUMAB QUANT - ARUP","code_information":[{"code":"3018239709","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82397","type":"HCPCS"}],"standard_charges":[{"gross_charge":368.75,"discounted_cash":368.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHLORIDE BLOOD","code_information":[{"code":"3018243501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.63,"discounted_cash":116.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHLORIDE BLOOD POC","code_information":[{"code":"3018243502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82435","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.63,"discounted_cash":116.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHLORIDE URINE TIMED","code_information":[{"code":"3018243601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.69,"discounted_cash":49.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHLORIDE URINE RANDOM","code_information":[{"code":"3018243606","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82436","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.69,"discounted_cash":49.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL FLUID","code_information":[{"code":"3018246501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.57,"discounted_cash":68.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY, BLD/SERUM CHOLESTEROL - CHOLESTEROL TOTAL","code_information":[{"code":"3018246502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82465","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.57,"discounted_cash":68.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CHROMIUM - CHROMIUM LEVEL","code_information":[{"code":"3018249501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.64,"discounted_cash":61.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHROMIUM LEVEL - ARUP","code_information":[{"code":"3018249502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82495","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.64,"discounted_cash":61.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CITRATE URINE CALCULI RISK ASSESSMENT - ARUP","code_information":[{"code":"3018250703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.75,"discounted_cash":46.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CITRATE 24 HOUR URINE - ARUP","code_information":[{"code":"3018250705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.54,"discounted_cash":19.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CITRIC ACID - KIDNEY STONE RISK PANEL URINE - ARUP","code_information":[{"code":"3018250706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.75,"discounted_cash":46.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CITRIC ACID - SUPERSATURATION PROFILE - ARUP","code_information":[{"code":"3018250707","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82507","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.54,"discounted_cash":19.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY FOR COLLAGEN CROSS LINKS - COLLAGEN TYPE I CROSSLINK","code_information":[{"code":"3018252301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.62,"discounted_cash":121.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C-TELOPEPTIDE, BETA-CROSS -LINKED, SERUM - ARUP","code_information":[{"code":"3018252305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.62,"discounted_cash":121.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N-TELOPEPTIDE, CROSS-LINKED, SERUM - ARUP","code_information":[{"code":"3018252306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.62,"discounted_cash":121.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N TELOPEPTIDE URINE - ARUP","code_information":[{"code":"3018252307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82523","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.28,"discounted_cash":41.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF COPPER - COPPER RANDOM URINE","code_information":[{"code":"3018252503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.54,"discounted_cash":19.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF COPPER - COPPER, SERUM","code_information":[{"code":"3018252504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82525","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.72,"discounted_cash":37.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CORTISOL, FREE - CORTISOL, FREE","code_information":[{"code":"3018253002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.03,"discounted_cash":58.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CORTISOL, FREE - CORTISOL, URINE, FREE","code_information":[{"code":"3018253003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.78,"discounted_cash":50.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CORTISOL FREE - ARUP","code_information":[{"code":"3018253004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.03,"discounted_cash":58.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CORTISOL FREE URINE - ARUP","code_information":[{"code":"3018253005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82530","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.78,"discounted_cash":50.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CORTISOL TOTAL","code_information":[{"code":"3018253301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.36,"discounted_cash":164.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOTAL CORTISOL AM - QWDL","code_information":[{"code":"3018253305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.02,"discounted_cash":213.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CORTISOL SALIVARY - ARUP","code_information":[{"code":"3018253309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CORTISOL INTERNAL SAMPLING - ARUP","code_information":[{"code":"3018253312","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82533","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.36,"discounted_cash":164.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CREATINE - CREATINE","code_information":[{"code":"3018254001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.72,"discounted_cash":78.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATINE LEVEL URINE","code_information":[{"code":"3018254002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.97,"discounted_cash":247.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATINE LEVEL -  ARUP","code_information":[{"code":"3018254003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.72,"discounted_cash":78.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATINE LEVEL URINE - ARUP","code_information":[{"code":"3018254004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82540","type":"HCPCS"}],"standard_charges":[{"gross_charge":247.97,"discounted_cash":247.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC COENZYME Q10","code_information":[{"code":"3018254204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.59,"discounted_cash":117.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC","code_information":[{"code":"3018254206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.73,"discounted_cash":64.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COL-CHR/MS NONDRUG ANALYTE NES QUAL/QUAN EA SPEC PARATHYROID HORMONE RELATED PEPTIDE","code_information":[{"code":"3018254207","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.59,"discounted_cash":117.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OMEGA 3 AND 6 FATTY ACIDS - QST","code_information":[{"code":"3018254211","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.73,"discounted_cash":64.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PTH-RELATED PEPTIDE - ARUP","code_information":[{"code":"3018254215","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82542","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.59,"discounted_cash":117.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CK (CPK) TOTAL","code_information":[{"code":"3018255001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.31,"discounted_cash":180.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CK (CPK) TOTAL - ARUP","code_information":[{"code":"3018255002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.31,"discounted_cash":180.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATINE KINASE (CPK) TOTAL W/ REFLEX CKMB","code_information":[{"code":"3018255004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.31,"discounted_cash":180.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATINE KINASE (CK) TOTAL","code_information":[{"code":"3018255006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.31,"discounted_cash":180.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATINE KINASE (CPK) TOTAL - CK ISOENZYMES - ARUP","code_information":[{"code":"3018255008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82550","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.31,"discounted_cash":180.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CPK ISOENZYMES","code_information":[{"code":"3018255201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATINE KINASE ISOENZYMES - CK ISOENZYMES - ARUP","code_information":[{"code":"3018255202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82552","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.89,"discounted_cash":18.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATINE, MB FRACTION - CKMB","code_information":[{"code":"3018255302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82553","type":"HCPCS"}],"standard_charges":[{"gross_charge":340.75,"discounted_cash":340.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL","code_information":[{"code":"3018256501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.28,"discounted_cash":133.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE, EGFR - CYSTATIN, CREATININE, EGFR - ARUP","code_information":[{"code":"3018256504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82565","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.28,"discounted_cash":133.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL RANDOM URINE","code_information":[{"code":"3018257001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.53,"discounted_cash":121.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF URINE CREATININE - CREATININE, URINE, 24 HOUR","code_information":[{"code":"3018257004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.53,"discounted_cash":121.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL BODY FLUID","code_information":[{"code":"3018257005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.53,"discounted_cash":121.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL - CALCIUM/CREATININE URINE RATIO","code_information":[{"code":"3018257006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.53,"discounted_cash":121.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL - ALBUMIN / CREATININE RATIO URINE - ARUP","code_information":[{"code":"3018257011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.53,"discounted_cash":121.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL - MICROALBUMIN/CREATININE RATIO RANDOME URINE MG/DL","code_information":[{"code":"3018257012","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.61,"discounted_cash":73.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL - MICROALBUMIN/CREATININE RATIO RANDOM URINE MG/L","code_information":[{"code":"3018257013","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.53,"discounted_cash":121.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL URINE 24 HOUR","code_information":[{"code":"3018257017","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.53,"discounted_cash":121.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE LEVEL - PROTEIN/CREATININE RATIO URINE","code_information":[{"code":"3018257018","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82570","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.53,"discounted_cash":121.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREATININE CLEARANCE URINE 24 HOUR","code_information":[{"code":"3018257501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82575","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.33,"discounted_cash":272.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF CRYOGLOBULIN - CRYOGLOBULIN","code_information":[{"code":"3018259501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82595","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.03,"discounted_cash":13.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYANIDE LEVEL - ARUP","code_information":[{"code":"3018260002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82600","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.57,"discounted_cash":77.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN B12 LEVEL","code_information":[{"code":"3018260701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82607","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.36,"discounted_cash":189.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC B-12 BINDING CAPACITY - B-12 BINDING CAPACITY","code_information":[{"code":"3018260801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82608","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.89,"discounted_cash":23.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYSTATIN C","code_information":[{"code":"3018261001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.48,"discounted_cash":76.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYSTATIN - CYSTATIN, CREATININE, EGFR - ARUP","code_information":[{"code":"3018261003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82610","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.48,"discounted_cash":76.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DEHYDROEPIANDROSTERONE - DHEA","code_information":[{"code":"3018262601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.44,"discounted_cash":43.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DEHYDROEPIANDROSTERONE (DHEA) - ARUP","code_information":[{"code":"3018262602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82626","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.44,"discounted_cash":43.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DEHYDROEPIANDROSTERONE-SULFATE - DHEA-SULFATE","code_information":[{"code":"3018262701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82627","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.34,"discounted_cash":64.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIHYDROTESTOSTERONE","code_information":[{"code":"3018264201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.38,"discounted_cash":99.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 5 A DIHYDROTESTOSTERONE - ARUP","code_information":[{"code":"3018264202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82642","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.38,"discounted_cash":99.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY, DIHYDROXYVITAMIN D W/FRACTIONS, IF PERFORMED - VITAMIN D 1","code_information":[{"code":"3018265201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.42,"discounted_cash":111.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN D 1,25 DIHYDROXY - ARUP","code_information":[{"code":"3018265202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82652","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.42,"discounted_cash":111.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PANCREATIC ELASTASE, FECAL, QUANT","code_information":[{"code":"3018265301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.49,"discounted_cash":66.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PANCREATIC ELASTASE STOOL QUANT - ARUP","code_information":[{"code":"3018265302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82653","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.49,"discounted_cash":66.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENZYME ACTIVITY NOS LYSOSOMAL ACID LIPASE","code_information":[{"code":"3018265704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.06,"discounted_cash":119.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA GALACTOSIDASE - ARUP","code_information":[{"code":"3018265710","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":438.86,"discounted_cash":438.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENZYME ACTIVITY NOS LYSOSOMAL ACID LIPASE - ARUP","code_information":[{"code":"3018265711","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82657","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.06,"discounted_cash":119.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ERYTHROPOIETIN - ERYTHROPOIETIN","code_information":[{"code":"3018266801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.82,"discounted_cash":24.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ERYTHROPOIETIN LEVEL - ARUP","code_information":[{"code":"3018266802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82668","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.82,"discounted_cash":24.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ESTRADIOL - ESTRADIOL","code_information":[{"code":"3018267001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ESTRADIOL LEVEL PEDIATRICS","code_information":[{"code":"3018267002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.59,"discounted_cash":13.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ESTRADIOL MALE, CHILD, POST-MENOPAUSE FEMALE BY MASS SPEC - ARUP","code_information":[{"code":"3018267004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82670","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.0,"discounted_cash":95.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ESTROGENS - ESTROGENS, FRACTIONATED","code_information":[{"code":"3018267101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.15,"discounted_cash":98.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ESTROGENS FRACTIONATED - ARUP","code_information":[{"code":"3018267102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82671","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.15,"discounted_cash":98.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ESTRIOL - ADDITIONAL CHARGE","code_information":[{"code":"3018267701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.04,"discounted_cash":59.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ESTRIOL LEVEL - ARUP","code_information":[{"code":"3018267703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82677","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.04,"discounted_cash":59.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ESTRONE - ESTRONE","code_information":[{"code":"3018267902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.44,"discounted_cash":43.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ESTRONE LEVEL - ARUP","code_information":[{"code":"3018267903","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82679","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.44,"discounted_cash":43.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ETHYLENE GLYCOL - ETHYLENE GLYCOL","code_information":[{"code":"3018269301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82693","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.96,"discounted_cash":39.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FECAL FAT QUAL","code_information":[{"code":"3018270501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82705","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.52,"discounted_cash":6.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF BLOOD FATTY ACIDS - FATTY ACIDS, FREE","code_information":[{"code":"3018272501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82725","type":"HCPCS"}],"standard_charges":[{"gross_charge":120.05,"discounted_cash":120.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FERRITIN LEVEL","code_information":[{"code":"3018272801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.02,"discounted_cash":176.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NON-ALCOHOLIC FATTY LIVER DISEASE PANEL - FERRITIN","code_information":[{"code":"3018272802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.9,"discounted_cash":189.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FERRITIN - LIVER FIBROSIS FIBROMETER NAFLD - ARUP","code_information":[{"code":"3018272805","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82728","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.9,"discounted_cash":189.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FOLATE LEVEL SERUM","code_information":[{"code":"3018274601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82746","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.52,"discounted_cash":209.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FOLATE RBC LEVEL","code_information":[{"code":"3018274701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82747","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.09,"discounted_cash":51.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IMMUNOGLOBULINS","code_information":[{"code":"3018278401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGG","code_information":[{"code":"3018278402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGM","code_information":[{"code":"3018278403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - IGA","code_information":[{"code":"3018278404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF GAMMAGLOBULIN IGA, IGD, IGG, IGM, EACH - CELIAC REFLEX PNL","code_information":[{"code":"3018278407","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.58,"discounted_cash":26.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGG LEVEL SERUM/CSF IGG SYNTH - ARUP","code_information":[{"code":"3018278408","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G CSF","code_information":[{"code":"3018278410","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.22,"discounted_cash":40.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G - IGG","code_information":[{"code":"3018278413","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN M - IGM","code_information":[{"code":"3018278414","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN A - IGA","code_information":[{"code":"3018278415","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGG LEVEL SERUM/CSF OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018278416","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GAMMAGLOBULIN G (IGG) - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3018278417","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GAMMAGLOBULIN A (IGA) - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3018278418","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GAMMAGLOBULIN M (IGM) - MONOCLONAL PROTEIN STUDY EXTENDED SERUM - ARUP","code_information":[{"code":"3018278419","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) CSF","code_information":[{"code":"3018278420","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN M (IGM) CSF - ARUP","code_information":[{"code":"3018278426","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN A (IGA) - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3018278430","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.58,"discounted_cash":26.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN D SERUM - ARUP","code_information":[{"code":"3018278431","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G(IGG)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278432","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN M(IGM)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278433","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN A(IGA)-IMMUNOGLOBULINS CRYOPRECIPITINS REFLEX SERUM- ARUP","code_information":[{"code":"3018278434","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G (IGG)","code_information":[{"code":"3018278437","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN A (IGA)","code_information":[{"code":"3018278441","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018278444","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - OLIGOCLONAL BAND PROFILE CSF - ARUP","code_information":[{"code":"3018278445","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G (IGG) - OLIGOCLONAL BAND PROFILE SERUM - ARUP","code_information":[{"code":"3018278446","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGG - IMMUNOGLOBULIN G (IGG) CSF INDEX - ARUP","code_information":[{"code":"3018278448","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82784","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.31,"discounted_cash":32.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN E - IGE","code_information":[{"code":"3018278501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82785","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.85,"discounted_cash":103.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 1","code_information":[{"code":"3018278701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.93,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGG1, 2, 3 OR 4, EACH - IGG 4","code_information":[{"code":"3018278704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":15.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN A SUBCLASSES","code_information":[{"code":"3018278706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.85,"discounted_cash":27.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G SUBCLASS 1 (IGG1)","code_information":[{"code":"3018278709","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.93,"discounted_cash":27.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G SUBCLASS 4 (IGG4)","code_information":[{"code":"3018278713","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":15.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN G SUBCLASSES 1 - 4","code_information":[{"code":"3018278714","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82787","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.52,"discounted_cash":15.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS VENOUS","code_information":[{"code":"3018280304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.63,"discounted_cash":391.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD GASES: PH, PO2 & PCO2 - BLOOD GAS ARTERIAL RT","code_information":[{"code":"3018280309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82803","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.63,"discounted_cash":391.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD GASES, O2 SAT ONLY - OXYGEN SATURATION, ARTERIAL","code_information":[{"code":"3018281001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":458.15,"discounted_cash":458.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD GASES, O2 SAT ONLY - OXYGEN SATURATION, ARTERIAL RT","code_information":[{"code":"3018281003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82810","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.24,"discounted_cash":354.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF GASTRIN - GASTRIN","code_information":[{"code":"3018294101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.02,"discounted_cash":51.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GASTRIN LEVEL - ARUP","code_information":[{"code":"3018294102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82941","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.02,"discounted_cash":51.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY GLUCOSE, BODY FLUID - GLUCOSE CSF","code_information":[{"code":"3018294501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.8,"discounted_cash":150.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE BODY FLUID","code_information":[{"code":"3018294502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82945","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.8,"discounted_cash":150.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - POCT GLUCOMETER","code_information":[{"code":"3018294701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.07,"discounted_cash":93.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE LEVEL FASTING","code_information":[{"code":"3018294703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.07,"discounted_cash":93.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE LEVEL","code_information":[{"code":"3018294704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.07,"discounted_cash":93.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY QUANTITATIVE,BLOOD GLUCOSE - GLUCOSE","code_information":[{"code":"3018294706","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.07,"discounted_cash":93.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - GLUCOSE","code_information":[{"code":"3018294708","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.07,"discounted_cash":93.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE LEVEL - LIVER FIBROSIS FIBROMETER NAFLD - ARUP","code_information":[{"code":"3018294709","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82947","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.07,"discounted_cash":93.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 1 HOUR SPECIMEN","code_information":[{"code":"3018295001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.15,"discounted_cash":44.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE TEST - POST GLUCOSE DOSE","code_information":[{"code":"3018295007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82950","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.15,"discounted_cash":44.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) FIRST 3 SPECIMENS, 2 HOUR GTT","code_information":[{"code":"3018295101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.61,"discounted_cash":211.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) FIRST 3 SPECIMENS","code_information":[{"code":"3018295102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.21,"discounted_cash":172.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LACTOSE TOLERANCE TEST (LTT) FIRST 3 SPECIMENS, 3 HOUR LTT","code_information":[{"code":"3018295109","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82951","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.7,"discounted_cash":44.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) 3 HOUR SPECIMEN","code_information":[{"code":"3018295201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.4,"discounted_cash":64.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE TOLERANCE TEST (GTT) EACH ADDITIONAL SPECIMEN","code_information":[{"code":"3018295204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82952","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.82,"discounted_cash":72.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF G6PD ENZYME - GLUCOSE 6 PHOSPHATE DEHYDROGENASE","code_information":[{"code":"3018295501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUCOSE 6 PHOSPHATE DEHYDROGENASE - ARUP","code_information":[{"code":"3018295502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82955","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.72,"discounted_cash":21.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GAMMA GT LEVEL","code_information":[{"code":"3018297701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.92,"discounted_cash":233.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIVER FIBROSIS PANEL - GGT","code_information":[{"code":"3018297703","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.92,"discounted_cash":233.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GGT - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018297705","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82977","type":"HCPCS"}],"standard_charges":[{"gross_charge":233.92,"discounted_cash":233.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUTATHIONE","code_information":[{"code":"3018297801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82978","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.96,"discounted_cash":186.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLYCATED PROTEIN - FRUCTOSAMINE","code_information":[{"code":"3018298504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":16.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FRUCTOSAMINE LEVEL - ARUP","code_information":[{"code":"3018298505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"82985","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.52,"discounted_cash":16.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GONADOTROPIN (FSH) - FSH","code_information":[{"code":"3018300101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83001","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LUTEINIZING HORMONE LEVEL","code_information":[{"code":"3018300201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.19,"discounted_cash":107.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LUTEINIZING HORMONE LEVEL","code_information":[{"code":"3018300204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.19,"discounted_cash":107.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LUTEINIZING HORMONE LEVEL - ARUP","code_information":[{"code":"3018300206","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83002","type":"HCPCS"}],"standard_charges":[{"gross_charge":107.19,"discounted_cash":107.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY GROWTH HORMONE (HGH) - GROWTH HORMONE","code_information":[{"code":"3018300301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83003","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.25,"discounted_cash":48.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HAPTOGLOBIN LEVEL","code_information":[{"code":"3018301001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83010","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.4,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC H. PYLORI;BREATH TEST, NON-ISOTOPE - H PYLORI BREATH TEST","code_information":[{"code":"3018301301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.69,"discounted_cash":204.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC H PYLORI C-13 BREATH TEST","code_information":[{"code":"3018301303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83013","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.94,"discounted_cash":194.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC H PYLORI DRUG ADMIN FOR C-13 BREATH TEST","code_information":[{"code":"3018301401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83014","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.63,"discounted_cash":20.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - COBALT","code_information":[{"code":"3018301801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.69,"discounted_cash":204.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC QUANTITATIVE SCREEN, METALS - IODINE","code_information":[{"code":"3018301811","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.69,"discounted_cash":204.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COBALT LEVEL WHOLE BLOOD","code_information":[{"code":"3018301812","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.45,"discounted_cash":95.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COBALT LEVEL SERUM/PLASMA - ARUP","code_information":[{"code":"3018301815","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.69,"discounted_cash":204.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TITANIUM LEVEL QUANT SERUM OR PLASMA - ARUP","code_information":[{"code":"3018301819","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.69,"discounted_cash":204.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COBALT LEVEL WHOLE BLOOD - ARUP","code_information":[{"code":"3018301822","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.45,"discounted_cash":95.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IODINE LEVEL, QUANTITATIVE, SERUM - ARUP","code_information":[{"code":"3018301824","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83018","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.69,"discounted_cash":204.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMOGLOBIN ELECTROPHORESIS","code_information":[{"code":"3018302001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.04,"discounted_cash":31.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CAPILLARY HEMOGLOBIN ELECTROPHORESIS - ARUP","code_information":[{"code":"3018302005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83020","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.04,"discounted_cash":31.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMOGLOBIN F EVALUATION BY HPLC W/REFLEX - ARUP","code_information":[{"code":"3018302101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.04,"discounted_cash":31.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMOGLOBIN S EVALUATION BY HPLC W/REFLEX - ARUP","code_information":[{"code":"3018302104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83021","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.04,"discounted_cash":31.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST - HEMOGLOBIN A1C","code_information":[{"code":"3018303601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.89,"discounted_cash":164.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLYCOSYLATED HEMOGLOBIN TEST - GLYCATED HEMOGLOBIN REFERRED","code_information":[{"code":"3018303603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83036","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.1,"discounted_cash":28.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD METHEMOGLOBIN, QUANT - METHEMOGLOBIN","code_information":[{"code":"3018305001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83050","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.83,"discounted_cash":59.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF PLASMA HEMOGLOBIN - HEMOGLOBIN PLASMA","code_information":[{"code":"3018305101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83051","type":"HCPCS"}],"standard_charges":[{"gross_charge":232.39,"discounted_cash":232.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF HISTAMINE - HISTAMINE","code_information":[{"code":"3018308801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83088","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.18,"discounted_cash":35.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HOMOCYSTEINE LEVEL","code_information":[{"code":"3018309002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83090","type":"HCPCS"}],"standard_charges":[{"gross_charge":131.2,"discounted_cash":131.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 5 HIAA QUANT URINE RANDOM - ARUP","code_information":[{"code":"3018349702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83497","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.67,"discounted_cash":42.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF PROGESTERONE 17-D - 17-HYDROXYPROGESTERONE","code_information":[{"code":"3018349801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.65,"discounted_cash":78.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 17 HYDROXYPROGESTERONE - ARUP","code_information":[{"code":"3018349803","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83498","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.65,"discounted_cash":78.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY NONANTIBODY - ANTIMULLERIAN HORMONE (AMH)","code_information":[{"code":"3018351607","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE","code_information":[{"code":"3018351611","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SERINE PROTEASE 3 ANTIBODY IGG","code_information":[{"code":"3018351612","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - HISTONE ANTIBODY","code_information":[{"code":"3018351613","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - CENTROMERE ANTIBODY IGG","code_information":[{"code":"3018351618","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.02,"discounted_cash":78.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - CHROMATIN ANTIBODY IGG","code_information":[{"code":"3018351619","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - GLOMERULAR BASEMENT MEMBRANE ANTIBODY IGG","code_information":[{"code":"3018351620","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOPEROXIDASE ANTIBODY IGG","code_information":[{"code":"3018351621","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.02,"discounted_cash":78.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE - GM1 GANGLIOSIDE ANTIBODY","code_information":[{"code":"3018351622","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETYLCHOLINE MODULATING ANTIBODY","code_information":[{"code":"3018351631","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY ANALYTE - 21 HYDROXYLASE","code_information":[{"code":"3018351632","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3018351642","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANCA SERINE PROTEASE 3 ANTIBODY (PRE) - (ARUP)","code_information":[{"code":"3018351649","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANCA MYELOPEROXIDASE ANTIBODY (MPO) - (ARUP)","code_information":[{"code":"3018351650","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.02,"discounted_cash":78.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG","code_information":[{"code":"3018351653","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3018351658","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3018351659","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.02,"discounted_cash":78.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 21 HYDROXYLASE AUTOANTIBODY - ARUP","code_information":[{"code":"3018351666","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CENTROMERE IGG - ARUP","code_information":[{"code":"3018351670","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.02,"discounted_cash":78.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHROMATIN IGG","code_information":[{"code":"3018351671","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 3-HYDROXY-3-METHYLGLUTARYL COENZYME A REDUCTASE (HMGCR) IGG- ARUP","code_information":[{"code":"3018351672","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GM1 IGG - GANGLIOSIDE GM1 ANTIBODIES IGG/IGM - ARUP","code_information":[{"code":"3018351675","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GM1 IGM - GANGLIOSIDE GM1 ANTIBODIES IGG/IGM - ARUP","code_information":[{"code":"3018351676","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GM1 IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351677","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GM1 IGM - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351678","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GD1B IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351679","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GD1B IGM- GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351680","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GQ1 IGG - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351681","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GQ1 IGM - GANGLIOSIDE GM1/GD1B/GQ1B IGG/IGM ANTIBODIES - ARUP","code_information":[{"code":"3018351682","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HISTONE IGG - ARUP","code_information":[{"code":"3018351690","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETYLCHOLINE BINDING ANTIBODY - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351694","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY- MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351695","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - MYELOPEROXIDASE / PROTEASE 3 AB - ARUP","code_information":[{"code":"3018351696","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.08,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - MYELOPEROXIDASE / PROTEASE 3 AB - ARUP","code_information":[{"code":"3018351697","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.08,"discounted_cash":32.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EJ (GLYCYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018351698","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC KU ANTIBODY - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018351699","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MI2 (NUCLEAR HELICASE PROTEIN) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OJ (ISOLEUCYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A2","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC P155/140 ANTIBODY - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A3","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PL12 (ALANYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A4","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PL7 (THREONYL TRNA SYNTHETASE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A5","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SRP (SIGNAL RECOGNITION PARTICLE) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"30183516A6","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SERINE PROTEASE 3 (PR3) IGG - MPO AND PR3 ANTIBODIES W/ RFLX ANCA- ARUP","code_information":[{"code":"30183516A7","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOPEROXIDASE (MPO) IGG - MPO AND PR3 ANTIBODIES W/ RFLX ANCA - ARUP","code_information":[{"code":"30183516A8","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.02,"discounted_cash":78.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RF IGG - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516B3","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RNA POLYMERASE III IGG - ARUP","code_information":[{"code":"30183516B4","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARBAMYLATED PROTEIN IGG - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"30183516B8","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CENTROMERE IGG -CONNECTIVE TISSUE DISEASES PROFILE - ARUP","code_information":[{"code":"30183516C1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.02,"discounted_cash":78.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RIBOSOMAL P ANTIBODY - CONNECTIVE TISSUE DISEASES PROFILE - ARUP","code_information":[{"code":"30183516C2","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLOMERULAR BASEMENT MEMBRANE (GBM) IGG","code_information":[{"code":"30183516C5","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLOMERULAR BASEMENT MEMBRANE (GBM) IGG BY MULTIPLEX BEAD ASSAY - ARUP","code_information":[{"code":"30183516C6","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.66,"discounted_cash":68.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RF IGA - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516C9","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RF IGM - RHEUMATOID FACTOR (RF) IGA IGG IGM - ARUP","code_information":[{"code":"30183516D1","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RIA IMMUNOASSAY NONINFECTIOUS ANALYTE","code_information":[{"code":"3018351904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.32,"discounted_cash":191.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSULIN LIKE GROWTH FACTOR BINDING PROTEIN 1","code_information":[{"code":"3018351907","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.86,"discounted_cash":60.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BINDING AB - ARUP","code_information":[{"code":"3018351908","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.62,"discounted_cash":49.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHANNEL ANTIBODY","code_information":[{"code":"3018351910","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.12,"discounted_cash":28.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VOLTAGE GATED POTASSIUM CHNL AB-AUTOIMMUNE ENCEPHALITIS EXTND PNL-ARUP","code_information":[{"code":"3018351933","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.12,"discounted_cash":28.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGF BINDING PROTEIN 1 - ARUP","code_information":[{"code":"3018351935","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.86,"discounted_cash":60.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STRIATED MUSCLE IGG - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3018351938","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.62,"discounted_cash":49.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROCOLLAGEN TYPE 1 PROPEPTIDE - ARUP","code_information":[{"code":"3018351940","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83519","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.32,"discounted_cash":191.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY NONINFECTIOUS ANALYTE QUANT","code_information":[{"code":"3018352005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY QUANT NOS NONAB - TSH RECPT","code_information":[{"code":"3018352012","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INHIBIN B","code_information":[{"code":"3018352025","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTERFERON GAMMA - ARUP","code_information":[{"code":"3018352031","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEPTIN LEVEL QUANT - ARUP","code_information":[{"code":"3018352055","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELIN-ASSOCIATED GLYCOPROTEIN (MAG) IGM, EIA - QDID","code_information":[{"code":"3018352056","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VON WILLEBRAND FACTOR COLLAGEN BINDING - ARUP","code_information":[{"code":"3018352057","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALPHA SUBUNIT OF PITUITARY GLYCOPROTEIN - ARUP","code_information":[{"code":"3018352076","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INHIBIN B - ARUP","code_information":[{"code":"3018352077","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTERLEUKIN 2 RECEPTOR BY MAFD - ARUP","code_information":[{"code":"3018352078","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TSH RECEPTOR ANTIBODY - ARUP","code_information":[{"code":"3018352081","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRYPTASE LEVEL - ARUP","code_information":[{"code":"3018352082","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MUTATED CITRULLINATED VIMENTIN ANTIBODY - ARUP","code_information":[{"code":"3018352083","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.77,"discounted_cash":355.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 14-3-3 ETA PROTEIN BY ELISA - ARUP","code_information":[{"code":"3018352091","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MUTATED CITRULLINATED VIMENTIN (MCV) ANTIBODY - QST","code_information":[{"code":"3018352092","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SULFATIDE AUTOANTIBODY TEST - QWDL","code_information":[{"code":"3018352095","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83520","type":"HCPCS"}],"standard_charges":[{"gross_charge":302.05,"discounted_cash":302.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN LIGHT CHAINS FREE EACH","code_information":[{"code":"3018352101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC KAPPA LIGHT CHAINS - MONOCLONAL PROTEIN STUDY EXTENDED SERUM -  ARUP  [3018352101]","code_information":[{"code":"3018352102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAMBDA LIGHT CHAINS - MONOCLONAL PROTEIN STUDY EXTENDED SERUM -  ARUP","code_information":[{"code":"3018352103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC KAPPA/LAMBDA IMMUNOGLOBULIN LIGHT CHAINS - IMMUNOFIXATION WITH FLC, URINE - ARUP","code_information":[{"code":"3018352104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC KAPPA LIGHT CHAINS - KAPPA LAMBDA QUANTITATIVE","code_information":[{"code":"3018352105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAMBDA LIGHT CHAINS - KAPPA LAMBDA QUANTITATIVE","code_information":[{"code":"3018352106","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC KAPPA LIGHT CHAINS - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3018352107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83521","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSULIN LEVEL TOTAL","code_information":[{"code":"3018352502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.09,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSULIN LEVEL TOTAL - INSULIN LEVEL FREE AND TOTAL - ARUP","code_information":[{"code":"3018352505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83525","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.09,"discounted_cash":33.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF INSULIN,FREE - INSULIN, FREE","code_information":[{"code":"3018352701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.74,"discounted_cash":33.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSULIN LEVEL FREE - INSULIN LEVEL FREE AND TOTAL - ARUP","code_information":[{"code":"3018352702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83527","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.74,"discounted_cash":33.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTERLEUKIN-6 (IL-6)","code_information":[{"code":"3018352901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83529","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.61,"discounted_cash":47.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IRON LEVEL","code_information":[{"code":"3018354002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.67,"discounted_cash":103.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IRON LEVEL TOTAL - IRON AND TIBC - ARUP","code_information":[{"code":"3018354004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.67,"discounted_cash":103.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IRON LEVEL","code_information":[{"code":"3018354007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83540","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.67,"discounted_cash":103.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOTAL IRON BINDING CAPACITY","code_information":[{"code":"3018355001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83550","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.95,"discounted_cash":141.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF LACTIC ACID - LACTATE CSF","code_information":[{"code":"3018360501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.38,"discounted_cash":195.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LACTIC ACID LEVEL","code_information":[{"code":"3018360502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.67,"discounted_cash":115.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LACTIC ACID LEVEL REFLEX","code_information":[{"code":"3018360510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.67,"discounted_cash":115.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POC LACTATE LEVEL ARTERIAL","code_information":[{"code":"3018360519","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.67,"discounted_cash":115.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POC LACTATE LEVEL VENOUS","code_information":[{"code":"3018360520","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.67,"discounted_cash":115.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LACTIC ACID LEVEL CSF","code_information":[{"code":"3018360521","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83605","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.38,"discounted_cash":195.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LACTATE DEHYDROGENASE (LDH) FLUID","code_information":[{"code":"3018361501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.95,"discounted_cash":155.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LD (LDH) TOTAL","code_information":[{"code":"3018361502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.95,"discounted_cash":155.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LACTATE DEHYDROGENASE TOTAL","code_information":[{"code":"3018361508","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.95,"discounted_cash":155.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LD 1 - LACTATE DEHYDROGENASE ISOENZYMES - ARUP","code_information":[{"code":"3018361510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83615","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.5,"discounted_cash":22.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LACTOFERRIN FECAL","code_information":[{"code":"3018363001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83630","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.0,"discounted_cash":67.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEAD URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018365501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":10.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEAD BLOOD  HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018365503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.76,"discounted_cash":66.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEAD BLOOD HEAVY METALS PANEL 4 - ARUP","code_information":[{"code":"3018365505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEAD VENOUS - ARUP","code_information":[{"code":"3018365506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.75,"discounted_cash":15.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEAD URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018365510","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83655","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.36,"discounted_cash":10.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPASE LEVEL","code_information":[{"code":"3018369001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.84,"discounted_cash":123.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF LIPASE - LIPASE BODY FLUID","code_information":[{"code":"3018369002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83690","type":"HCPCS"}],"standard_charges":[{"gross_charge":215.52,"discounted_cash":215.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN SMALL A","code_information":[{"code":"3018369501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":26.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN SMALL A PANEL COMPONENT","code_information":[{"code":"3018369502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.47,"discounted_cash":39.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN SMALL A - CARDIO IQ - QWDL","code_information":[{"code":"3018369503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83695","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.47,"discounted_cash":39.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY LIPOPROTEIN PLA2 - LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2","code_information":[{"code":"3018369801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.17,"discounted_cash":153.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN-PLA2 (PLAC) ACTIVITY - ARUP","code_information":[{"code":"3018369802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83698","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.17,"discounted_cash":153.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN, BLOOD, BY NMR SPECT - LIPOPROTEIN NMR","code_information":[{"code":"3018370401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.95,"discounted_cash":98.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN  BLOOD  BY NMR SPECT - LIPOPROTEIN","code_information":[{"code":"3018370402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.24,"discounted_cash":94.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN - NMR LIPOMED PROFILE - ARUP","code_information":[{"code":"3018370403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.95,"discounted_cash":98.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIPOPROTEIN BY NMR SPECT - CARDIO IQ - QWDL","code_information":[{"code":"3018370404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83704","type":"HCPCS"}],"standard_charges":[{"gross_charge":94.24,"discounted_cash":94.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF BLOOD LIPOPROTEIN,HDL CHOLEST - HDL CHOLESTEROL","code_information":[{"code":"3018371801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83718","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.4,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF BLOOD LIPOPROTEIN,LDL CHOLEST - LDL CHOLESTEROL DIRECT","code_information":[{"code":"3018372101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83721","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.07,"discounted_cash":17.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MAGNESIUM LEVEL","code_information":[{"code":"3018373501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.85,"discounted_cash":159.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MAGNESIUM URINE RANDOM","code_information":[{"code":"3018373502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.85,"discounted_cash":159.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MAGNESIUM SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018373507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.85,"discounted_cash":159.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MAGNESIUM - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018373511","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.85,"discounted_cash":159.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MAGNESIUM RBC - ARUP","code_information":[{"code":"3018373512","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83735","type":"HCPCS"}],"standard_charges":[{"gross_charge":159.85,"discounted_cash":159.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MASS SPECTROMETRY NONDRUG ANALYTE","code_information":[{"code":"3018378901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.11,"discounted_cash":172.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BILE ACIDS FRACTIONATED AND TOTAL - ARUP","code_information":[{"code":"3018378904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.11,"discounted_cash":172.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIAL ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.11,"discounted_cash":172.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FUNGAL ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378906","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.11,"discounted_cash":172.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AFB ID BY MALDI-TOF MS - ARUP","code_information":[{"code":"3018378907","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83789","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.11,"discounted_cash":172.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MERCURY URINE HEAVY METALS PANEL 3- ARUP","code_information":[{"code":"3018382501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.56,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MERCURY BLOOD HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018382503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.49,"discounted_cash":14.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MERCURY BLOOD - ARUP","code_information":[{"code":"3018382504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.06,"discounted_cash":17.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MERCURY BLOOD HEAVY METALS PANEL 4 BLOOD - ARUP","code_information":[{"code":"3018382505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.06,"discounted_cash":17.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MERCURY URINE - HEAVY METALS PANEL 3 - ARUP","code_information":[{"code":"3018382506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83825","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.56,"discounted_cash":16.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF METANEPHRINES - METANEPHRINES 24HR URINE","code_information":[{"code":"3018383501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.03,"discounted_cash":56.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF METANEPHRINES - METANEPHRINE PLASMA","code_information":[{"code":"3018383502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC METANEPHRINES URINE 24 HOUR - ARUP","code_information":[{"code":"3018383505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83835","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.03,"discounted_cash":56.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELIN BASIC PROTEIN,CSF - MYELIN BASIC PROTEIN CSF","code_information":[{"code":"3018387301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":26.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELIN BASIC PROTEIN CSF - ARUP","code_information":[{"code":"3018387302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83873","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.89,"discounted_cash":26.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF MYOGLOBIN - MYOGLOBIN SERUM","code_information":[{"code":"3018387401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.79,"discounted_cash":17.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYOGLOBIN URINE SCREEN","code_information":[{"code":"3018387403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83874","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.51,"discounted_cash":15.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N-TERMINAL PRO-BNP","code_information":[{"code":"3018388001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83880","type":"HCPCS"}],"standard_charges":[{"gross_charge":346.62,"discounted_cash":346.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEPHELOMETRY ALPHA 2 MACROGLOBULIN","code_information":[{"code":"3018388303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":45.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEPHELOMETRY RETINOL BINDING PROTEIN","code_information":[{"code":"3018388306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":642.87,"discounted_cash":642.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A2 MACROGLOBULIN-LIVER FIBROSIS CHRONIC VIRAL HEP FIBROMETER PNL-ARUP","code_information":[{"code":"3018388309","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83883","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.11,"discounted_cash":45.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NICKEL LEVEL - ARUP","code_information":[{"code":"3018388503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83885","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.46,"discounted_cash":15.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEOTIDASE 5","code_information":[{"code":"3018391501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.69,"discounted_cash":20.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEOTIDASE 5 - ARUP","code_information":[{"code":"3018391502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83915","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.69,"discounted_cash":20.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OLIGOCLONAL BANDS IN CSF AND SERUM - ARUP","code_information":[{"code":"3018391601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.83,"discounted_cash":102.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OLIGOCLONAL BANDS CSF & SERUM - ARUP","code_information":[{"code":"3018391602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.83,"discounted_cash":102.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OLIGOCLONAL BANDS NUMBER CSF - OLIGOCLONAL BAND PROFILE - ARUP","code_information":[{"code":"3018391604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83916","type":"HCPCS"}],"standard_charges":[{"gross_charge":102.83,"discounted_cash":102.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY ORGANIC ACIDS QUANTITATIVE - ORGANIC ACIDS URINE","code_information":[{"code":"3018391801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.3,"discounted_cash":68.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ORGANIC ACIDS URINE QUANT - ARUP","code_information":[{"code":"3018391802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83918","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.3,"discounted_cash":68.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY SNGL ORGANIC ACID, QUANTITATIVE - METHYLMALONIC ACID, SERUM","code_information":[{"code":"3018392101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.56,"discounted_cash":29.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC METHYLMALONIC ACID LEVEL SERUM - ARUP","code_information":[{"code":"3018392104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83921","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.56,"discounted_cash":29.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OSMOLALITY SERUM/PLASMA","code_information":[{"code":"3018393001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83930","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.45,"discounted_cash":145.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OSMOLALITY URINE","code_information":[{"code":"3018393501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83935","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.45,"discounted_cash":145.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF OSTEOCALCIN - OSTEOCALCIN","code_information":[{"code":"3018393701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83937","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.4,"discounted_cash":71.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OSTEOCALCIN - ARUP","code_information":[{"code":"3018393702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83937","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.5,"discounted_cash":92.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OXALATE SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018394502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.36,"discounted_cash":54.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OXALIC ACID - KIDNEY STONE RISK PANEL URINE - ARUP","code_information":[{"code":"3018394506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.95,"discounted_cash":53.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OXALATE - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018394507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83945","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.36,"discounted_cash":54.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PTH INTACT","code_information":[{"code":"3018397001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":853.72,"discounted_cash":853.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PTH INTACT - PTH INTACT WITH CALCIUM - ARUP","code_information":[{"code":"3018397005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83970","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PH BODY FLUID","code_information":[{"code":"3018398601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":424.05,"discounted_cash":424.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PH BODY FLUID NOS - PH STOOL","code_information":[{"code":"3018398603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83986","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.61,"discounted_cash":18.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALPROTECTIN FECAL - ARUP","code_information":[{"code":"3018399301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.96,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALPROTECTIN FECAL","code_information":[{"code":"3018399303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":150.0,"discounted_cash":150.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALPROTECTIN STOOL - ARUP","code_information":[{"code":"3018399304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"83993","type":"HCPCS"}],"standard_charges":[{"gross_charge":173.96,"discounted_cash":173.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY PHOSPHATASE ACID PROSTATIC - PROSTATIC ACID PHOSPHATASE","code_information":[{"code":"3018406601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84066","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.22,"discounted_cash":18.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALKALINE PHOSPHATASE LEVEL","code_information":[{"code":"3018407501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.4,"discounted_cash":96.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALKALINE PHOSPHATASE - ARUP","code_information":[{"code":"3018407503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84075","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALKALINE PHOSPHATASE ISOENZYMES ARUP","code_information":[{"code":"3018408001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.93,"discounted_cash":23.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY ALKAL PHOSPHATASE,ISOENZYMES - ALKALINE PHOSPHATASE,ISOENZYMES BONE","code_information":[{"code":"3018408002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.93,"discounted_cash":164.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALKALINE PHOSPHOTASE BONE SPECIFIC - ARUP","code_information":[{"code":"3018408003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84080","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.93,"discounted_cash":164.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHOSPHORUS","code_information":[{"code":"3018410004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84100","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.08,"discounted_cash":87.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF URINE PHOSPHORUS - PHOSPHORUS RANDOM URINE","code_information":[{"code":"3018410501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.54,"discounted_cash":8.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHOSPHORUS URINE CALCULI RISK ASSESSMENT - ARUP","code_information":[{"code":"3018410504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.22,"discounted_cash":86.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHOSPHORUS - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018410506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84105","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.54,"discounted_cash":8.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FRACTIONATED PORPHYRINS URINE","code_information":[{"code":"3018412001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.84,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FRACTIONATED PORPHYRINS URINE - ARUP","code_information":[{"code":"3018412003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84120","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.84,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POTASSIUM LEVEL","code_information":[{"code":"3018413201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84132","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.01,"discounted_cash":105.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POTASSIUM RANDOM URINE","code_information":[{"code":"3018413303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.62,"discounted_cash":80.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POTASSIUM URINE 24 HOUR","code_information":[{"code":"3018413307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.62,"discounted_cash":80.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POTASSIUM - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018413310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84133","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.62,"discounted_cash":80.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PREALBUMIN","code_information":[{"code":"3018413401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84134","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.91,"discounted_cash":88.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF PREGNENOLONE - PREGNENOLONE","code_information":[{"code":"3018414001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.77,"discounted_cash":41.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PREGNENOLONE LEVEL - ARUP","code_information":[{"code":"3018414003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84140","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.77,"discounted_cash":41.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF 17-HYDROXYPREGNENOLONE - 17-HYDROXYPREGNENOLONE","code_information":[{"code":"3018414301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84143","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.77,"discounted_cash":41.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF PROGESTERONE - PROGESTERONE","code_information":[{"code":"3018414401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":57.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROGESTERONE LEVEL","code_information":[{"code":"3018414402","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84144","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.5,"discounted_cash":57.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROCALCITONIN LEVEL","code_information":[{"code":"3018414501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84145","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.64,"discounted_cash":243.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROLACTIN","code_information":[{"code":"3018414601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84146","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.76,"discounted_cash":264.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN (PSA) TOTAL","code_information":[{"code":"3018415301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.79,"discounted_cash":220.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN,TOTAL - PSA TOTAL AND FREE","code_information":[{"code":"3018415302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.33,"discounted_cash":206.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PSA SCREEN","code_information":[{"code":"3018415304","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.33,"discounted_cash":206.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PSA TOTAL DIAGNOSTIC","code_information":[{"code":"3018415308","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.79,"discounted_cash":220.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PSA TOTAL SCREENING","code_information":[{"code":"3018415310","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.33,"discounted_cash":206.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PSA ULTRASENSITIVE - ARUP","code_information":[{"code":"3018415311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84153","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.66,"discounted_cash":228.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PSA FREE","code_information":[{"code":"3018415401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROSTATE SPECIFIC ANTIGEN, FREE - PSA TOTAL AND FREE","code_information":[{"code":"3018415403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84154","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.18,"discounted_cash":22.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOTAL","code_information":[{"code":"3018415501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.37,"discounted_cash":75.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOTAL - PROTEIN ELECTROPHORESIS, SERUM - ARUP","code_information":[{"code":"3018415506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.44,"discounted_cash":61.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOTAL - PROTEIN ELECTROPHORESIS REFLEX IFE - ARUP","code_information":[{"code":"3018415507","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84155","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.99,"discounted_cash":26.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN RANDOM URINE","code_information":[{"code":"3018415601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.13,"discounted_cash":91.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOT XCPT REFRACTOMETRY URINE - BENCE JONES PROTOCOL","code_information":[{"code":"3018415605","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.96,"discounted_cash":89.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOTAL URINE IMMUNOFIXATION WITH FLC - ARUP","code_information":[{"code":"3018415606","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.82,"discounted_cash":60.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN URINE 24 HOUR","code_information":[{"code":"3018415609","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.13,"discounted_cash":91.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN LEVEL - PROTEIN/CREATININE RATIO URINE","code_information":[{"code":"3018415610","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.13,"discounted_cash":91.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOTAL - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3018415611","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.71,"discounted_cash":23.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOTAL - IMMUNOFIXATION URINE - ARUP","code_information":[{"code":"3018415613","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.96,"discounted_cash":89.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOTAL PROTEIN - MONOCLONAL PROTEIN STUDY, URINE - ARUP","code_information":[{"code":"3018415614","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84156","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.13,"discounted_cash":91.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOT XCPT REFRACTOMETRY OTH SRC - PROTEIN CSF","code_information":[{"code":"3018415701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.21,"discounted_cash":147.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN TOTAL BODY FLUID","code_information":[{"code":"3018415702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.21,"discounted_cash":147.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOTAL PROTEIN CSF","code_information":[{"code":"3018415704","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84157","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.21,"discounted_cash":147.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN ELECTROPHORESIS SERUM","code_information":[{"code":"3018416501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.08,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN ELECTROPHORESIS REFLEX IFE/IG - ARUP","code_information":[{"code":"3018416505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.08,"discounted_cash":31.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN ELECTROPHORESIS, SERUM - ARUP","code_information":[{"code":"3018416506","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84165","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.63,"discounted_cash":32.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN E-PHORESIS/URINE/CSF - PROTEIN ELECTROPHORESIS URINE","code_information":[{"code":"3018416601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.12,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PE CSF - PROTEIN ELECTROPHORESIS CSF - ARUP","code_information":[{"code":"3018416602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN ELECTROPHORESIS, URINE, 24 HOUR","code_information":[{"code":"3018416603","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.12,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN ELECTROPHORESIS, URINE RANDOM","code_information":[{"code":"3018416604","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.12,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN ELECTROPHORESIS - MONOCLONAL PROTEIN STUDY, URINE - ARUP","code_information":[{"code":"3018416605","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84166","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.12,"discounted_cash":162.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST - HSV WESTERN BLOT","code_information":[{"code":"3018418101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.3,"discounted_cash":40.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MAG ANTIBODY WITH REFLEX - QDID","code_information":[{"code":"3018418104","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84181","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.3,"discounted_cash":49.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN, WESTERN BLOT TEST, W BAND ID","code_information":[{"code":"3018418203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY PROTEIN, WESTERN BLOT TEST, W BAND ID - IMMUNOLOGICAL PROBE","code_information":[{"code":"3018418209","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.13,"discounted_cash":57.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTEIN WESTERN BLOT AMPHIPHYSIN AB IGG","code_information":[{"code":"3018418210","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.51,"discounted_cash":80.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRION PROTEIN RT QUIC - 14 3 3 PROTEIN CSF - ARUP","code_information":[{"code":"3018418211","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MDA5 (CADM 140) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018418223","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NXP2 (NUCLEAR MATRIX PROTEIN) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018418224","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SAE1 (SUMO ACTIVATING ENZYME) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018418225","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TIF1 GAMMA (155 KDA) - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3018418226","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HU IGG - NEURONAL NUCLEAR ANTIBODIES IGG IMMUNOBLOT BLOT - ARUP","code_information":[{"code":"3018418227","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RI IGG - NEURONAL NUCLEAR ANTIBODIES IGG IMMUNOBLOT BLOT - ARUP","code_information":[{"code":"3018418228","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR/DNER IGG - NEURONAL NUCLEAR ANTIBODIES IGG IMMUNOBLOT BLOT - ARUP","code_information":[{"code":"3018418229","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC YO IGG - NEURONAL NUCLEAR ANTIBODIES IGG IMMUNOBLOT BLOT - ARUP","code_information":[{"code":"3018418230","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEURONAL ANTIBODY (AMPHIPHYSIN) -PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3018418231","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SOX1 IGG IMMUNOBLOT - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3018418232","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.61,"discounted_cash":96.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMPHIPHYSIN ANTIBODY-AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3018418239","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.13,"discounted_cash":57.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SOX1 IGG IB - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF","code_information":[{"code":"3018418240","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84182","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.13,"discounted_cash":57.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF PROINSULIN - PROINSULIN","code_information":[{"code":"3018420601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84206","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.53,"discounted_cash":31.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VITAMIN B-6 - VITAMIN B6","code_information":[{"code":"3018420701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.45,"discounted_cash":77.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN B6 - ARUP","code_information":[{"code":"3018420702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84207","type":"HCPCS"}],"standard_charges":[{"gross_charge":77.45,"discounted_cash":77.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RENIN DIRECT LEVEL  - ARUP","code_information":[{"code":"3018424401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.89,"discounted_cash":284.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RENIN ACTIVITY  - ARUP","code_information":[{"code":"3018424404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RENIN ACTIVITY - ALDOSTERONE/RENIN ACTIVITY RATIO - ARUP","code_information":[{"code":"3018424405","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84244","type":"HCPCS"}],"standard_charges":[{"gross_charge":227.72,"discounted_cash":227.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VITAMIN B-2 - VITAMIN B2","code_information":[{"code":"3018425201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.03,"discounted_cash":260.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN B2 - ARUP","code_information":[{"code":"3018425202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84252","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.03,"discounted_cash":260.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF SELENIUM - SELENIUM SERUM","code_information":[{"code":"3018425501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.37,"discounted_cash":70.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SELENIUM SERUM - ARUP","code_information":[{"code":"3018425503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84255","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.37,"discounted_cash":70.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF SEROTONIN - SEROTONIN SERUM","code_information":[{"code":"3018426001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84260","type":"HCPCS"}],"standard_charges":[{"gross_charge":152.75,"discounted_cash":152.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF SEX HORMONE BINDING GLOBULIN - SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"3018427001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":25.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN - TESTOSTERONE FREE AND TOTAL ADULT MALE","code_information":[{"code":"3018427003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":25.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN","code_information":[{"code":"3018427008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":25.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SEX HORMONE BINDING GLOBULIN-TESTOSTERONE FREE & TOTAL FEMALE/CHILD-ARUP","code_information":[{"code":"3018427011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84270","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.66,"discounted_cash":25.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SODIUM LEVEL","code_information":[{"code":"3018429501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84295","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.09,"discounted_cash":99.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SODIUM LEVEL URINE RANDOM","code_information":[{"code":"3018430001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.18,"discounted_cash":97.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF URINE SODIUM - SODIUM 24 HOUR URINE","code_information":[{"code":"3018430003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.18,"discounted_cash":97.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SODIUM URINE - ARUP","code_information":[{"code":"3018430006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.18,"discounted_cash":97.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SODIUM - SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018430008","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84300","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.18,"discounted_cash":97.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SODIUM STOOL - ARUP","code_information":[{"code":"3018430205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84302","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.05,"discounted_cash":35.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF SOMATOMEDIN - INSULIN-LIKE GROWTH FACTOR","code_information":[{"code":"3018430501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.64,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSULIN LIKE GROWTH FACTOR (IGF) 1 - ARUP","code_information":[{"code":"3018430502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84305","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.64,"discounted_cash":23.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF SOMATOSTATIN - SOMATOSTATIN","code_information":[{"code":"3018430701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84307","type":"HCPCS"}],"standard_charges":[{"gross_charge":283.95,"discounted_cash":283.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPECTROPHOTOMETRY - PORPHYRIN TOTAL","code_information":[{"code":"3018431101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPECTROPHOTOMETRY - CHOLESTEROL TOTAL BODY FLUID","code_information":[{"code":"3018431103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.61,"discounted_cash":73.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PORPHYRIN TOTAL - ARUP","code_information":[{"code":"3018431107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ADENOSINE DEAMINASE, PERICARDIAL FLUID - ARUP","code_information":[{"code":"3018431112","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84311","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REDUCING SUBSTANCES STOOL - ARUP","code_information":[{"code":"3018437602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84376","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.88,"discounted_cash":10.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REDUCING SUBSTANCES SINGLE QUANT","code_information":[{"code":"3018437802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.14,"discounted_cash":38.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 1,5 ANHYDROGLUCITOL QUANT","code_information":[{"code":"3018437804","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84378","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.14,"discounted_cash":38.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SULFATE - SUPERSATURATION PROFILE - ARUP","code_information":[{"code":"3018439202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84392","type":"HCPCS"}],"standard_charges":[{"gross_charge":134.95,"discounted_cash":134.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF TESTOSTERONE - TESTOSTERONE TOTAL FREE","code_information":[{"code":"3018440201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84402","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.2,"discounted_cash":70.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF TOTAL TESTOSTERONE - TESTOSTERONE","code_information":[{"code":"3018440301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.79,"discounted_cash":279.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL - TESTOSTERONE FREE AND TOTAL MALE ADULT","code_information":[{"code":"3018440302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.79,"discounted_cash":279.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TESTOSTERONE TOTAL LEVEL- TESTOSTERONE, BIOAVAILABLE & SHBG ADULT MALE","code_information":[{"code":"3018440305","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.79,"discounted_cash":279.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TESTOSTERONE TOTAL LEVEL","code_information":[{"code":"3018440306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.79,"discounted_cash":279.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TESTOSTERONE LEVEL - NG/ML","code_information":[{"code":"3018440307","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.79,"discounted_cash":279.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL - TESTOSTERONE FREE & TOTAL FEMALE/CHILD - ARUP","code_information":[{"code":"3018440311","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.79,"discounted_cash":279.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TESTOSTERONE LEVEL TOTAL FEMALE/CHILD - ARUP","code_information":[{"code":"3018440312","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84403","type":"HCPCS"}],"standard_charges":[{"gross_charge":279.79,"discounted_cash":279.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VITAMIN B-1 - VITAMIN B1","code_information":[{"code":"3018442501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.21,"discounted_cash":70.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VITAMIN B-1 - VITAMIN B1, WHOLE BLOOD","code_information":[{"code":"3018442502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.8,"discounted_cash":29.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN B1 - ARUP","code_information":[{"code":"3018442504","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.21,"discounted_cash":70.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN B1 WHOLE BLOOD - ARUP","code_information":[{"code":"3018442505","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84425","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.8,"discounted_cash":29.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF THYROGLOBULIN - THYROGLOBULIN","code_information":[{"code":"3018443201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.4,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROGLOBULIN BY CIA","code_information":[{"code":"3018443203","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.4,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROGLOBULIN CIA - ARUP","code_information":[{"code":"3018443204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.4,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROGLOBULIN LC - ARUP","code_information":[{"code":"3018443205","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84432","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.4,"discounted_cash":36.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY THIOPURIN S-MTHYLTRNSFRS (TPMT)","code_information":[{"code":"3018443301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.11,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THIOPURIN S-METHYLTRANSFERASE (TPMT) RBC - ARUP","code_information":[{"code":"3018443302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84433","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.11,"discounted_cash":61.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROXINE T4 TOTAL","code_information":[{"code":"3018443601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84436","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.77,"discounted_cash":199.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T4 FREE - THYROXINE FREE","code_information":[{"code":"3018443901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.84,"discounted_cash":57.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T4 FREE BY DIALYSIS - ARUP","code_information":[{"code":"3018443902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84439","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.84,"discounted_cash":57.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF THYROXINE BNDNG GLOBULIN - THYROXINE BINDING GLOBULIN","code_information":[{"code":"3018444201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84442","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROID STIMULATING HORMONE","code_information":[{"code":"3018444301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.31,"discounted_cash":238.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TSH LEVEL","code_information":[{"code":"3018444303","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.31,"discounted_cash":238.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TSH LEVEL - TSH REFLEX FREE T4","code_information":[{"code":"3018444306","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84443","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.31,"discounted_cash":238.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF THYROID STIM IMMUNOGLOBULINS (TSI) - THYROID STIMULATING IM","code_information":[{"code":"3018444501","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.26,"discounted_cash":81.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROID STIMULATING IMMUNOGLOBULINS (TSI) - ARUP","code_information":[{"code":"3018444502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84445","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.26,"discounted_cash":81.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VITAMIN E - VITAMIN E (TOCOPHEROL)","code_information":[{"code":"3018444601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.69,"discounted_cash":20.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN E (TOCOPHEROL) - ARUP","code_information":[{"code":"3018444602","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84446","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.69,"discounted_cash":20.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AST (SGOT) SERUM/PLASMA","code_information":[{"code":"3018445001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.86,"discounted_cash":78.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIVER FIBROSIS PANEL - AST","code_information":[{"code":"3018445004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.59,"discounted_cash":110.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - AST","code_information":[{"code":"3018445005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.59,"discounted_cash":110.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASPARTATE AMINOTRANSFERASE (AST)- LIVER FIBROSIS FIBROMETER NAFLD - ARUP","code_information":[{"code":"3018445006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.59,"discounted_cash":110.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AST - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018445007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84450","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.59,"discounted_cash":110.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALT (SPGT) SERUM/PLASMA","code_information":[{"code":"3018446001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.86,"discounted_cash":78.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIVER FIBROSIS PANEL - ALT","code_information":[{"code":"3018446004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.02,"discounted_cash":119.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NON ALCOHOLIC FATTY LIVER DISEASE PANEL - ALT","code_information":[{"code":"3018446005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.02,"discounted_cash":119.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALANINE AMINOTRANSFERASE (ALT) - LIVER FIBROSIS FIBROMETER NAFLD - ARUP","code_information":[{"code":"3018446006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.02,"discounted_cash":119.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALT - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018446007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84460","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.02,"discounted_cash":119.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRANSFERRIN LEVEL","code_information":[{"code":"3018446601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84466","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.72,"discounted_cash":171.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRIGLYCERIDES","code_information":[{"code":"3018447801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.47,"discounted_cash":145.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF TRIGLYCERIDES - TRIGLYCERIDES BODY FLUID","code_information":[{"code":"3018447802","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84478","type":"HCPCS"}],"standard_charges":[{"gross_charge":145.47,"discounted_cash":145.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE","code_information":[{"code":"3018447901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.02,"discounted_cash":205.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROID HORM UPTAKE/THYR HORM BINDING RATIO - T3 UPTAKE AND FTI","code_information":[{"code":"3018447902","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.02,"discounted_cash":205.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T3 UPTAKE - ARUP","code_information":[{"code":"3018447904","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.02,"discounted_cash":205.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T3 UPTAKE - THYROID PANEL WITH FTI- ARUP","code_information":[{"code":"3018447905","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84479","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.02,"discounted_cash":205.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRIIODOTHYRONINE TOTAL ASSAY, TT-3 - T3 (THYROID HORMONE)","code_information":[{"code":"3018448001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84480","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.37,"discounted_cash":75.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T3 FREE","code_information":[{"code":"3018448101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84481","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.26,"discounted_cash":205.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRIIODOTHYRONINE T3 REVERSE - T3 REVERSE","code_information":[{"code":"3018448201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.87,"discounted_cash":75.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRIIODOTHYRONINE (T3) REVERSE - ARUP","code_information":[{"code":"3018448202","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84482","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.87,"discounted_cash":75.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TROPONIN T HIGH SENSITIVITY","code_information":[{"code":"3018448401","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.05,"discounted_cash":459.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TROPONIN T QUANT HIGH SENSITIVITY","code_information":[{"code":"3018448404","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84484","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.05,"discounted_cash":459.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD UREA NITROGEN - BUN","code_information":[{"code":"3018452001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.82,"discounted_cash":133.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY UREA NITROGEN, QUAN - POCT UREA (BUN)","code_information":[{"code":"3018452004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.82,"discounted_cash":133.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BUN - LIVER FIBROSIS CHRONIC VIRAL HEPATITIS FIBROMETER PANEL - ARUP","code_information":[{"code":"3018452007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84520","type":"HCPCS"}],"standard_charges":[{"gross_charge":133.82,"discounted_cash":133.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC UREA NITROGEN URINE RANDOM","code_information":[{"code":"3018454002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84540","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.67,"discounted_cash":115.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URIC ACID LEVEL","code_information":[{"code":"3018455001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84550","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.86,"discounted_cash":78.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URIC ACID LEVEL URINE 24 HOUR","code_information":[{"code":"3018456004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.65,"discounted_cash":108.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URIC ACID SUPERSATURATION PROFILE, URINE - ARUP","code_information":[{"code":"3018456005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.1,"discounted_cash":88.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URIC ACID URINE RANDOM","code_information":[{"code":"3018456007","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.65,"discounted_cash":108.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URIC ACID LEVEL BODY FLUID - ARUP","code_information":[{"code":"3018456009","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.65,"discounted_cash":108.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URIC ACID - KIDNEY STONE RISK PANEL URINE - ARUP","code_information":[{"code":"3018456011","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84560","type":"HCPCS"}],"standard_charges":[{"gross_charge":108.65,"discounted_cash":108.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF URINE VMA - VMA, URINE","code_information":[{"code":"3018458502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.1,"discounted_cash":73.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VANILLYLMANDELIC ACID (VMA) URINE - ARUP","code_information":[{"code":"3018458503","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84585","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.1,"discounted_cash":73.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VIP - VASOACTIVE INTESTINAL PEPTIDE (VIP)","code_information":[{"code":"3018458601","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84586","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.31,"discounted_cash":39.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VASOPRESSIN - ARGININE VASOPRESSIN HORMONE","code_information":[{"code":"3018458801","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84588","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.4,"discounted_cash":106.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VITAMIN A - VITAMIN A","code_information":[{"code":"3018459001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.87,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN A - ARUP","code_information":[{"code":"3018459002","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84590","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.87,"discounted_cash":19.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF NOS VITAMIN - NIACIN (VITAMIN B3)","code_information":[{"code":"3018459101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF NOS VITAMIN - BIOTIN (VITAMIN B7)","code_information":[{"code":"3018459103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.98,"discounted_cash":208.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NIACIN (VITAMIN B3) - ARUP","code_information":[{"code":"3018459105","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.11,"discounted_cash":25.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN B7 (BIOTIN) LEVEL - ARUP","code_information":[{"code":"3018459107","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84591","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.98,"discounted_cash":208.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF VITAMIN K - VITAMIN K","code_information":[{"code":"3018459701","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.55,"discounted_cash":76.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAMIN K - ARUP","code_information":[{"code":"3018459702","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84597","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.55,"discounted_cash":76.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROPYLENE GLYCOL - ARUP","code_information":[{"code":"3018460004","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84600","type":"HCPCS"}],"standard_charges":[{"gross_charge":157.44,"discounted_cash":157.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ZINC - ZINC","code_information":[{"code":"3018463001","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.97,"discounted_cash":32.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF ZINC - ZINC RBC","code_information":[{"code":"3018463003","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":79.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ZINC LEVEL RBC - ARUP","code_information":[{"code":"3018463005","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":79.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ZINC WHOLE BLOOD - ARUP","code_information":[{"code":"3018463006","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84630","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.67,"discounted_cash":37.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY OF C-PEPTIDE - C-PEPTIDE","code_information":[{"code":"3018468101","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84681","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.36,"discounted_cash":57.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUANT - HCG QUANTITATIVE BLOOD","code_information":[{"code":"3018470201","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.43,"discounted_cash":337.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUANT - HCG TUMOR MARKER","code_information":[{"code":"3018470204","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.43,"discounted_cash":337.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HCG QUANTITATIVE TUMOR MARKER BLOOD","code_information":[{"code":"3018470207","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84702","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.43,"discounted_cash":337.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HCG PREGNANCY URINE QUAL","code_information":[{"code":"3018470301","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":170.03,"discounted_cash":170.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHORIONIC GONADOTROPIN, QUAL - HCG QUALITATIVE SERUM PLASMA","code_information":[{"code":"3018470302","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84703","type":"HCPCS"}],"standard_charges":[{"gross_charge":169.97,"discounted_cash":169.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLINICAL CHEMISTRY TEST - OSMOLALITY STOOL","code_information":[{"code":"3018499901","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.11,"discounted_cash":33.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OSMOLALITY STOOL - ARUP","code_information":[{"code":"3018499909","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.11,"discounted_cash":33.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POTASSIUM STOOL - ARUP","code_information":[{"code":"3018499910","type":"CDM"},{"code":"0301","type":"RC"},{"code":"84999","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.05,"discounted_cash":35.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNFIX E-PHORSIS URINE - IMMUNOFIXATION WITH FLC, URINE - ARUP","code_information":[{"code":"3018633502","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.58,"discounted_cash":50.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ZINC TRANSPROTER 8 ANTIBODY - ARUP","code_information":[{"code":"3018634103","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.22,"discounted_cash":86.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE ANTIBODY, IGG","code_information":[{"code":"3018636401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE ANTIBODY, IGA","code_information":[{"code":"3018636402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - CELIAC CASCADE SCREEN","code_information":[{"code":"3018636403","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA WITH REFLEX TITER - ARUP","code_information":[{"code":"3018636406","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG","code_information":[{"code":"3018636407","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG - ARUP","code_information":[{"code":"3018636408","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA","code_information":[{"code":"3018636409","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RHEUMATOID FACTOR - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"3018643102","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.46,"discounted_cash":37.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BIOFIRE RESP PNL 22 TARGETS INCLUDING SARSCOV2","code_information":[{"code":"3020202U01","type":"CDM"},{"code":"0302","type":"RC"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2469.6,"discounted_cash":2469.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESP PNL 21 TARGETS INCLUDING SARSCOV2","code_information":[{"code":"3020225U01","type":"CDM"},{"code":"0302","type":"RC"},{"code":"0225U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.66,"discounted_cash":1003.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FIBRILLARIN (U3 RNP) IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028351604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TITIN AB - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028351605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"83516","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.75,"discounted_cash":183.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BAKER'S YEAST IGG","code_information":[{"code":"3028600104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BARLEY IGG","code_information":[{"code":"3028600105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, BEEF IGG","code_information":[{"code":"3028600106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CHICKEN IGG","code_information":[{"code":"3028600107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CHOCOLATE IGG","code_information":[{"code":"3028600108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.92,"discounted_cash":30.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, CORN IGG","code_information":[{"code":"3028600110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, EGG WHITE IGG","code_information":[{"code":"3028600111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, LETTUCE IGG","code_information":[{"code":"3028600114","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, MALT IGG","code_information":[{"code":"3028600115","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, MILK (COW'S) IGG","code_information":[{"code":"3028600116","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, OAT IGG","code_information":[{"code":"3028600118","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, ORANGE IGG","code_information":[{"code":"3028600121","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, PEANUT IGG","code_information":[{"code":"3028600122","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, PORK IGG","code_information":[{"code":"3028600123","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, RYE IGG","code_information":[{"code":"3028600126","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - ALLERGEN, FOOD, SOYBEAN IGG","code_information":[{"code":"3028600127","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.92,"discounted_cash":30.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - TOMATO","code_information":[{"code":"3028600139","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - WHEAT","code_information":[{"code":"3028600140","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGG QUANT,EACH - WHITE POTATO","code_information":[{"code":"3028600141","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PEANUT IGG - ARUP","code_information":[{"code":"3028600148","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CASEIN (COW'S MILK) IGG - ARUP","code_information":[{"code":"3028600149","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86001","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.91,"discounted_cash":60.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST ALMONDS IGE","code_information":[{"code":"3028600303","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN ASH, WHITE IGE","code_information":[{"code":"3028600308","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST RABBIT EPITHELIUM IGE - ARUP","code_information":[{"code":"302860030D","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST DOG DANDER IGE - ARUP","code_information":[{"code":"302860030H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CAT HAIR DANDER IGE - ARUP","code_information":[{"code":"302860030L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES FARINAE (HOUSE DUST MITE) IGE - ARUP","code_information":[{"code":"302860030S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST ASPERGILLUS FUMAGATUS IGE","code_information":[{"code":"3028600310","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN ASPERGILLUS NIGER IGE","code_information":[{"code":"3028600311","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BARLEY IGE","code_information":[{"code":"3028600314","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BAYBERRY/SWEET GALE IGE - ARUP","code_information":[{"code":"3028600318","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST GERMAN COCKROACH IGE","code_information":[{"code":"302860031B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN VENOM: EUROPEAN PAPER WASP","code_information":[{"code":"302860031G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BEECH AMERICAN IGE","code_information":[{"code":"3028600320","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BEEF IGE","code_information":[{"code":"3028600321","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BERMUDA GRASS IGE","code_information":[{"code":"3028600323","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BIRCH TREE IGE","code_information":[{"code":"3028600324","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN BRAZIL NUT IGE","code_information":[{"code":"3028600329","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BERMUDA GRASS IGE - ARUP","code_information":[{"code":"302860032B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST ASH, WHITE IGE - ARUP","code_information":[{"code":"302860032D","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST OAK, WHITE IGE - ARUP","code_information":[{"code":"302860032G","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":99.34,"discounted_cash":99.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST SYCAMORE, AMERICAN IGE - ARUP","code_information":[{"code":"302860032H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.11,"discounted_cash":43.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST FESCUE, MEADOW IGE","code_information":[{"code":"302860032J","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: RJUG R 1 WALNUT","code_information":[{"code":"302860032L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BROCCOLI IGE - ARUP","code_information":[{"code":"302860032Z","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CABBAGE IGE","code_information":[{"code":"3028600335","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CANDIDA ALBICANS IGE - ARUP","code_information":[{"code":"3028600336","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CANDIDA ALBICANS IGE","code_information":[{"code":"3028600337","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CHICKEN FEATHERS IGE - ARUP","code_information":[{"code":"3028600339","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST MOUSE EPIPHELIUM IGE","code_information":[{"code":"302860033H","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":12.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CYPRESS,BALD (WHITE) IGE - ARUP","code_information":[{"code":"302860033K","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST DOCKWEED, YELLOW IGE - ARUP","code_information":[{"code":"302860033L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST ALTERNARIA ALTERNATA IGE - ARUP","code_information":[{"code":"302860033X","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST MUCOR RACEMOSUS IGE","code_information":[{"code":"302860033Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.5,"discounted_cash":12.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CARROT IGE","code_information":[{"code":"3028600340","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CASHEW IGE","code_information":[{"code":"3028600342","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CAT HAIR DANDER IGE","code_information":[{"code":"3028600344","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PISTACHIO IGE - ARUP","code_information":[{"code":"302860034A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: CATFISH","code_information":[{"code":"302860034C","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PINE, WHITE IGE - ARUP","code_information":[{"code":"302860034J","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST HORSE DANDER IGE - ARUP","code_information":[{"code":"302860034Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST WALNUT TREE IGE - ARUP","code_information":[{"code":"302860034R","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CHICKEN IGE","code_information":[{"code":"3028600353","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CLAMS IGE","code_information":[{"code":"3028600359","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST RAGWEED SHORT/COMMON IGE - ARUP","code_information":[{"code":"302860035P","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST COCONUT IGE","code_information":[{"code":"3028600363","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CODFISH IGE","code_information":[{"code":"3028600364","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CORN IGE","code_information":[{"code":"3028600366","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST COTTONWOOD TREE IGE","code_information":[{"code":"3028600369","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.67,"discounted_cash":49.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST OLIVE TREE IGE - ARUP","code_information":[{"code":"302860036A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST COTTONWOOD TREE IGE - ARUP","code_information":[{"code":"302860036B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.67,"discounted_cash":49.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FOOD: SWEET CHESTNUT","code_information":[{"code":"302860036I","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CORN SMUT IGE - ARUP","code_information":[{"code":"302860036J","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN TREE: MULBERRY (MORUS ALBA) IGE","code_information":[{"code":"302860036U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST ASPERGILLUS FUMAGATUS IGE - ARUP","code_information":[{"code":"302860036Y","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CRAB IGE","code_information":[{"code":"3028600371","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST MAPLE SUGAR TREE IGE - ARUP","code_information":[{"code":"302860037A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST ALTERNARIA ALTERNATA  IGE","code_information":[{"code":"302860037S","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST ELM TREE IGE","code_information":[{"code":"3028600386","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST WEED ENGLISH PLANTAIN IGE","code_information":[{"code":"3028600387","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST WEED ENGLISH PLANTAIN IGE - ARUP","code_information":[{"code":"3028600389","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BAHIA GRASS IGE","code_information":[{"code":"302860038A","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN CHEESE MOLD IGE","code_information":[{"code":"302860038E","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CEDAR, MOUNTAIN IGE - ARUP","code_information":[{"code":"302860038L","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.67,"discounted_cash":49.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES FARINAE (HOUSE DUST MITE) IGE","code_information":[{"code":"302860038U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST DERMATOPHAGOIDES PTERONYSSINUS (HOUSE DUST MITE) IGE","code_information":[{"code":"302860038V","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST DOG DANDER IGE","code_information":[{"code":"302860038Z","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST FENNEL, DOG IGE - ARUP","code_information":[{"code":"3028600391","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST FESCUE, MEADOW IGE - ARUP","code_information":[{"code":"3028600393","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FIRE ANT (INVICTA) IGE","code_information":[{"code":"3028600395","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN FLOUNDER IGE","code_information":[{"code":"3028600396","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST EGG WHITE IGE","code_information":[{"code":"302860039B","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST HELMINTHOSPORIUM SETOMELANOMMA ROSTRATA IGE","code_information":[{"code":"302860039K","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORMODENDRUM HORDEI","code_information":[{"code":"302860039M","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST HORMODENDRUM (CLADOSPORIUM) IGE - ARUP","code_information":[{"code":"302860039N","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST JOHNSON GRASS IGE","code_information":[{"code":"302860039Q","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST EUCALYPTUS TREE IGE - ARUP","code_information":[{"code":"302860039T","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST MESQUITE TREE IGE - ARUP","code_information":[{"code":"302860039U","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MAPLE,RED IGE","code_information":[{"code":"302860039X","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST GIANT RAGWEED IGE - ARUP","code_information":[{"code":"30286003A4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST WESTERN WATER HEMP (AMARANTHUS SPP) IGE - ARUP","code_information":[{"code":"30286003A5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PENICILLIUM NOTATUM IGE - ARUP","code_information":[{"code":"30286003A9","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST COW MILK IGE","code_information":[{"code":"30286003AA","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST OAK TREE RED IGE","code_information":[{"code":"30286003AG","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PECAN TREE IGE","code_information":[{"code":"30286003AP","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PENICILLIUM NOTATUM IGE","code_information":[{"code":"30286003AQ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST POTATO, WHITE IGE","code_information":[{"code":"30286003AZ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST RAGWEED, GIANT IGE","code_information":[{"code":"30286003B0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST MOUSE EPITHELIUM IGE - ARUP","code_information":[{"code":"30286003B2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN SYCAMORE, AMERICAN IGE","code_information":[{"code":"30286003BZ","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.11,"discounted_cash":43.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PEANUT IGE","code_information":[{"code":"30286003C3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST WILLOW TREE IGE - ARUP","code_information":[{"code":"30286003C6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST TIMOTHY GRASS IGE","code_information":[{"code":"30286003CB","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST GLUTEN IGE","code_information":[{"code":"30286003D0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PECAN NUT IGE","code_information":[{"code":"30286003D3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST JUNE GRASS IGE","code_information":[{"code":"30286003DA","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN EACH","code_information":[{"code":"30286003DB","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN YELLOW JACKET IGE","code_information":[{"code":"30286003F6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN LAMB IGE","code_information":[{"code":"30286003H1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN GRAPE IGE","code_information":[{"code":"30286003I0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST LAMB'S QUARTER IGE","code_information":[{"code":"30286003I1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MUSSEL IGE","code_information":[{"code":"30286003I2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN RICE IGE","code_information":[{"code":"30286003I4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN THISTLE, RUSSIAN IGE","code_information":[{"code":"30286003I5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST HOUSE DUST STIER IGE","code_information":[{"code":"30286003J0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST HOUSE DUST GREER IGE - ARUP","code_information":[{"code":"30286003J8","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST NETTLE WEED IGE","code_information":[{"code":"30286003K2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN PEPPER, GREEN BELL IGE","code_information":[{"code":"30286003K3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN RYE IGE","code_information":[{"code":"30286003K4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST TOMATO IGE","code_information":[{"code":"30286003K5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST HACKBERRY IGE - ARUP","code_information":[{"code":"30286003M0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST OAK, LIVE/VIRGINIA IGE - ARUP","code_information":[{"code":"30286003M2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN LETTUCE IGE","code_information":[{"code":"30286003N1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST OAT IGE","code_information":[{"code":"30286003N2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST TUNA IGE","code_information":[{"code":"30286003N5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PIGWEED ROUGH IGE","code_information":[{"code":"30286003O3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST FOOD HAZELNUT (FILBERT) IGE","code_information":[{"code":"30286003P0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST LOBSTER IGE","code_information":[{"code":"30286003P1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PINE TREE AUSTRALIAN IGE","code_information":[{"code":"30286003P3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CARELESS WEED IGE - ARUP","code_information":[{"code":"30286003P6","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST SCALLOP IGE","code_information":[{"code":"30286003Q4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HICKORY, WHITE IGE","code_information":[{"code":"30286003R0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST SESAME SEED IGE","code_information":[{"code":"30286003R4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN WALNUT TREE IGE","code_information":[{"code":"30286003R5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST WALNUT IGE","code_information":[{"code":"30286003S5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HOUSE DUST: HOLLISTER IGE","code_information":[{"code":"30286003T0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST ORANGE IGE","code_information":[{"code":"30286003T2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PORK IGE","code_information":[{"code":"30286003T3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST SHEEP SORREL (DOCK) IGE","code_information":[{"code":"30286003T4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST MUCOR RACEMOSUS IGE - ARUP","code_information":[{"code":"30286003TT","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST MAPLE TREE BOX ELDER IGE","code_information":[{"code":"30286003U1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.67,"discounted_cash":49.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST SHRIMP IGE","code_information":[{"code":"30286003U4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MICROORGANISM: ALTERNARIA ALTERNATA","code_information":[{"code":"30286003U8","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HONEYBEE IGE","code_information":[{"code":"30286003V0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN MARSHELDER, ROUGH IGE","code_information":[{"code":"30286003V1","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST WHEAT IGE","code_information":[{"code":"30286003V5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN OYSTER IGE","code_information":[{"code":"30286003W2","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.37,"discounted_cash":7.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST CULTIVATED WHEAT POLLEN IGE - ARUP","code_information":[{"code":"30286003W5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST BROME GRASS IGE - ARUP","code_information":[{"code":"30286003X7","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.11,"discounted_cash":15.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORNET, WHITE FACE IGE","code_information":[{"code":"30286003Y0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.39,"discounted_cash":14.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST SOYBEAN IGE","code_information":[{"code":"30286003Y4","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":6.7,"discounted_cash":6.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - ALLERGEN HORNET, YELLOW IGE","code_information":[{"code":"30286003Z0","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST RAGWEED SHORT/COMMON IGE","code_information":[{"code":"30286003Z3","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.58,"discounted_cash":71.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST PINE, WHITE IGE","code_information":[{"code":"30286003Z5","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86003","type":"HCPCS"}],"standard_charges":[{"gross_charge":5.63,"discounted_cash":5.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - PURIFIED COMPONENT EACH","code_information":[{"code":"3028600801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.46,"discounted_cash":97.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST OVALBUMIN EGG IGE","code_information":[{"code":"3028600804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.46,"discounted_cash":97.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGY TEST OVOMUCOID EGG IGE","code_information":[{"code":"3028600805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.46,"discounted_cash":97.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ALLERGEN SPEC IGE - EGG COMPONENT PANEL IGE","code_information":[{"code":"3028600806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86008","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI-SMOOTH MUSCLE ANTIBODY","code_information":[{"code":"3028601502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC F ACTIN SMOOTH MUSCLE IGA - ARUP","code_information":[{"code":"3028601503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMOOTH MUSCLE IGG","code_information":[{"code":"3028601504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86015","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WBC ANTIBODY IDENTIFICATION - ANTI-NEUTROPHIL ANTIBODY","code_information":[{"code":"3028602101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86021","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.13,"discounted_cash":147.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELET ANTIBODIES - HEPARIN-INDUCED PLATELET ANTIBODY","code_information":[{"code":"3028602201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.82,"discounted_cash":406.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELET ANTIBODY SCREEN INDIRECT","code_information":[{"code":"3028602202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.82,"discounted_cash":406.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPARIN ANTIBODY","code_information":[{"code":"3028602204","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.82,"discounted_cash":406.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SEROTONIN RELEASE UNFRACTIONATED HEPARIN - VERSITI","code_information":[{"code":"3028602205","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.82,"discounted_cash":406.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPARIN-INDUCED PLATELET ANTIBODY","code_information":[{"code":"3028602211","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86022","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.82,"discounted_cash":406.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOGLOBULIN ASSAY - PLATELET ANTIBODIES, DIRECT","code_information":[{"code":"3028602301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86023","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.64,"discounted_cash":80.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI NEUTROPHIL CYTO ANTIBY SCREEN","code_information":[{"code":"3028603601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANCA - INFLAMMATORY BOWEL DISEASE PANEL - ARUP","code_information":[{"code":"3028603602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.13,"discounted_cash":34.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI NEUTROPHIL CYTOPLASMIC ANTIBODY (ANCA)","code_information":[{"code":"3028603605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANCA - ANCA ASSOCIATED VASCULITIS PROFILE - ARUP","code_information":[{"code":"3028603606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86036","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.13,"discounted_cash":34.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTINEUTROPHIL CYTOPLASMIC ANTIBODIES, TITER, FA","code_information":[{"code":"3028603701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANCA TITER AND PATTERN","code_information":[{"code":"3028603702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86037","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANA (ANTINUCLEAR ANTIBODIES)","code_information":[{"code":"3028603801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.56,"discounted_cash":118.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANA - ANTINUCLEAR ANTIBODY WRFLX TITER - ARUP","code_information":[{"code":"3028603802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":199.3,"discounted_cash":199.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANA - LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028603805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86038","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANA TITER","code_information":[{"code":"3028603902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.77,"discounted_cash":30.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANA TITER -  ANTINUCLEAR ANTIBODY HEP-2 IGG W REFLEX - ARUP","code_information":[{"code":"3028603904","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":38.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANA TITER - ANTINUCLEAR ANTIBODY HEP-2 IGG - ARUP","code_information":[{"code":"3028603907","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86039","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.2,"discounted_cash":38.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BINDING ANTIBODY - ARUP","code_information":[{"code":"3028604101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.62,"discounted_cash":49.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACHR BINDING ANTIBODY - ACETYLCHOLINE RECEPTOR AB W/REFLEX PANEL - ARUP","code_information":[{"code":"3028604102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":191.32,"discounted_cash":191.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACHR BINDING ANTIBODY - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028604103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86041","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETYLCHOLINE RECEPTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3028604201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACHR BLOCKING ANTIBODY - ACETYLCHOLINE RECEPTOR AB W/REFLEX PANEL - ARUP","code_information":[{"code":"3028604202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACHR BLOCKING ANTIBODY - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028604203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86042","type":"HCPCS"}],"standard_charges":[{"gross_charge":78.75,"discounted_cash":78.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACETYLCHOLINE REC (ACHR) MOD AB","code_information":[{"code":"3028604301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86043","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.14,"discounted_cash":117.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AQUAPORIN-4 RECEPTOR AB","code_information":[{"code":"3028605101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86051","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AQUAPORIN 4 REC AB CSF","code_information":[{"code":"3028605201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC - AQUAPHORIN - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028605203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86052","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.22,"discounted_cash":33.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTISTREPTOLYSIN O TITER - ANTISTREPTOLYSIN O TITER","code_information":[{"code":"3028606001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86060","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.13,"discounted_cash":21.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTISTREPTOLYSIN O SCREEN - ANTI-STREPTOLYSIN O","code_information":[{"code":"3028606301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86063","type":"HCPCS"}],"standard_charges":[{"gross_charge":10.23,"discounted_cash":10.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CRP (C-REACTIVE PROTEIN) INFLAMMATORY","code_information":[{"code":"3028614001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.09,"discounted_cash":154.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C REACTIVE PROTEIN LEVEL MG/L INFLAMMATORY","code_information":[{"code":"3028614003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86140","type":"HCPCS"}],"standard_charges":[{"gross_charge":154.09,"discounted_cash":154.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CRP (C-REACTIVE PROTEIN) HIGH SENSITIVITY - CARDIAC","code_information":[{"code":"3028614101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.9,"discounted_cash":194.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C REACTIVE PROTEIN HIGH SENSITIVITY CARDIAC MG/L","code_information":[{"code":"3028614104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86141","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.9,"discounted_cash":194.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BETA 2 GLYCOPROTEIN I ANTIBODY,EA - BETA-2 GLYCOPROTEIN ABS","code_information":[{"code":"3028614601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.76,"discounted_cash":178.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BETA-2 GLYCOPROTEIN ABS IGG - PHOSLIPID ARUP","code_information":[{"code":"3028614605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.76,"discounted_cash":178.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BETA-2 GLYCOPROTEIN ABS IGM - PHOSLIPID ARUP","code_information":[{"code":"3028614606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.76,"discounted_cash":178.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGG - BETA 2 GLYCOPROTEIN 1 IGG IGM - ARUP","code_information":[{"code":"3028614611","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.76,"discounted_cash":178.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BETA 2 GLYCOPROTEIN 1 IGM - BETA 2 GLYCOPROTEIN 1 IGG IGM - ARUP","code_information":[{"code":"3028614612","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86146","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.76,"discounted_cash":178.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGA ARUP","code_information":[{"code":"3028614702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.15,"discounted_cash":70.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGG ARUP","code_information":[{"code":"3028614703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.15,"discounted_cash":70.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGM ARUP","code_information":[{"code":"3028614704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.15,"discounted_cash":70.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGA - ARUP","code_information":[{"code":"3028614707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.32,"discounted_cash":30.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN ANTIBODY IGG - ARUP","code_information":[{"code":"3028614708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.31,"discounted_cash":30.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN IGG - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3028614710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.32,"discounted_cash":30.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN IGM - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3028614711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN IGG - CARDIOLIPIN IGG IGM ANTIBODIES - ARUP","code_information":[{"code":"3028614712","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.32,"discounted_cash":30.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOLIPIN IGM - CARDIOLIPIN IGG IGM ANTIBODIES - ARUP","code_information":[{"code":"3028614713","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86147","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.25,"discounted_cash":26.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHOSPHOLIPID ANTIBODY - PHOSPHATIDYLSERINE ANTIBODIES","code_information":[{"code":"3028614801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86148","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.03,"discounted_cash":273.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COLD AGGLUTININ SCREEN - COLD AGGLUTININ SCREEN REF LAB","code_information":[{"code":"3028615602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COLD AGGLUTININ SCREEN - ARUP","code_information":[{"code":"3028615603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86156","type":"HCPCS"}],"standard_charges":[{"gross_charge":7.7,"discounted_cash":7.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C4 COMPLEMENT","code_information":[{"code":"3028616001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.08,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C3 COMPLEMENT","code_information":[{"code":"3028616002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.08,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COMPLEMENT, ANTIGEN - C1 ESTERASE INHIBITOR COMPLEMENT","code_information":[{"code":"3028616004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.39,"discounted_cash":21.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COMPLEMENT, ANTIGEN - C1 COMPLEMENT","code_information":[{"code":"3028616005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.67,"discounted_cash":49.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C4 LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028616013","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.3,"discounted_cash":29.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C3 LUPUS COMPREHENSIVE REFLEXIVE PANEL - ARUP","code_information":[{"code":"3028616015","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.51,"discounted_cash":29.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C3 COMPLEMENT - ARUP","code_information":[{"code":"3028616018","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86160","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.08,"discounted_cash":33.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C1 ESTERASE INHIBITOR FUNCTIONAL -  ARUP","code_information":[{"code":"3028616102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86161","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.4,"discounted_cash":41.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COMPLEMENT, TOTAL (CH50) - COMPLEMENT TOTAL","code_information":[{"code":"3028616201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.01,"discounted_cash":56.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COMPLEMENT TOTAL (CH50) - ARUP","code_information":[{"code":"3028616202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86162","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.01,"discounted_cash":56.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYCLIC CIRULLINATED PEPTIDE ANTIBODY - CYCLIC CITRUL PEPTIDE ANTIBDY","code_information":[{"code":"3028620001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.39,"discounted_cash":24.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYCLIC CIRULLINATED PEPTIDE IGG/A - RHEUMATOID ARTHRITIS PANEL - ARUP","code_information":[{"code":"3028620002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.39,"discounted_cash":24.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYCLIC CITRUL PEPTIDE (CCP) IGG & IGA - ARUP","code_information":[{"code":"3028620004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.39,"discounted_cash":24.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYCLIC CITRULLINATED PEPTIDE IGG","code_information":[{"code":"3028620005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86200","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.39,"discounted_cash":24.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI DNA DOUBLE STRANDED","code_information":[{"code":"3028622501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.26,"discounted_cash":16.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI DNA DOUBLE STRANDED - ARUP","code_information":[{"code":"3028622503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.67,"discounted_cash":127.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DNA ANTIBODY DOUBLE STRANDED IGG W/REFLEX TO IFA TITER - ARUP","code_information":[{"code":"3028622505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86225","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.26,"discounted_cash":16.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENDOMYSIAL IGA - ARUP","code_information":[{"code":"3028623106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86231","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.33,"discounted_cash":33.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-A EXT NU AB","code_information":[{"code":"3028623501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SJOGRENS SYNDROME-B EXT NUC AB","code_information":[{"code":"3028623502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - ANTI JO-1 IGG","code_information":[{"code":"3028623503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SCLERODERMA SCL-70 IGG - SYSTEMIC SCLEROSIS PROFILE - ARUP","code_information":[{"code":"3028623504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - RIBOSOMAL P PROTEIN ANTIBODY","code_information":[{"code":"3028623505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.39,"discounted_cash":277.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES","code_information":[{"code":"3028623506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RNA POLYMERASE III IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEAR ANTIGEN ANTIBODY - SMITH ANTIBODY","code_information":[{"code":"3028623508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SCLERODERMA (SCL-70) ANTIBODY- SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623511","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RNA POLYMERASE III IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623513","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RIBOSOMAL P PROTEIN IGG - ARUP","code_information":[{"code":"3028623516","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.39,"discounted_cash":277.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI SMITH ANTIBODY","code_information":[{"code":"3028623517","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RIBONUCLEIC PROTEIN (RNP) IGG","code_information":[{"code":"3028623518","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA (RO) IGG","code_information":[{"code":"3028623519","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSB (LA) IGG","code_information":[{"code":"3028623520","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSB (LA) IGG - ARUP","code_information":[{"code":"3028623521","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA52 (RO52) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES - ARUP","code_information":[{"code":"3028623522","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA60 (RO60) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES - ARUP","code_information":[{"code":"3028623523","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSB (LA) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES ARUP","code_information":[{"code":"3028623524","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMITH ENA IGG - ENA ANTIBODIES - ARUP","code_information":[{"code":"3028623525","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMITH/RNP ENA IGG - ENA ANTIBODIES - ARUP","code_information":[{"code":"3028623526","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSB (LA) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623527","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.39,"discounted_cash":277.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA52 (RO52) IGG - EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623528","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA60 (RO60) IGG- EXTRACTABLE NUCLEAR ANTIGEN ANTIBODIES- ARUP","code_information":[{"code":"3028623529","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JO1 IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623532","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PMSCL 100 IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623533","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FIBRILLARIN (U3 RNP) IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623534","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA52 (RO52) ENA IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623535","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA60 (RO60) IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623536","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMITH RNP IGG - EXTENDED MYOSITIS PANEL - ARUP","code_information":[{"code":"3028623537","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SCLERODERMA SCL70 ENA IGG - ARUP","code_information":[{"code":"3028623539","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMITH ENA IGG - ARUP","code_information":[{"code":"3028623540","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMITH RNP ENA IGG - ARUP","code_information":[{"code":"3028623541","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA52 (RO52) ENA IGG - SSA RO ANTIBODY - ARUP","code_information":[{"code":"3028623542","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.3,"discounted_cash":59.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMITH/RNP ENA IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623543","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PM/SCL 100 IGG - SYSTEMIC SCLEROSIS PANEL - ARUP","code_information":[{"code":"3028623544","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA52 (RO52) IGG - CONNECTIVE TISSUE DISEASE PROFILE - ARUP","code_information":[{"code":"3028623545","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSA60 (RO60) IGG - CONNECTIVE TISSUE DISEASE PROFILE - ARUP","code_information":[{"code":"3028623546","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SSB (LA) IGG - CONNECTIVE TISSUE DISEASE PANEL - ARUP","code_information":[{"code":"3028623547","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.42,"discounted_cash":49.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JO1 IGG - CONNECT TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623548","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SCLERODERMA SCL-70 ANTIBODY - CONNECT TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623549","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMITH ANTIBODY - CONNECTIVE TISSUE DIS PROFILE - ARUP","code_information":[{"code":"3028623550","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.63,"discounted_cash":16.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SCLERODERMA SCL-70 ANTIBODY","code_information":[{"code":"3028623552","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86235","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - SCREEN EACH","code_information":[{"code":"3028625504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUORESCENT ANTIBODY; SCREEN - GLOMERULAR BASEMT MEMB IGG AB","code_information":[{"code":"3028625505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.51,"discounted_cash":290.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - STRIATED MUSCLE ANTIBODY","code_information":[{"code":"3028625507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N-METHYL-D-ASPARTATE RECEPTOR ANTIBODY","code_information":[{"code":"3028625509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N-METHYL-D-ASPARTATE RECEPTOR ANTIBODY CSF","code_information":[{"code":"3028625510","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES PCCA/ANNA","code_information":[{"code":"3028625512","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES PCCA/ANNA CSF","code_information":[{"code":"3028625513","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N METHYL D ASPARTATE (NMDA) RECEPTOR IGG WITH REFLEX CSF - ARUP","code_information":[{"code":"3028625531","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES (PCCA/ANNA) CSF - ARUP","code_information":[{"code":"3028625532","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MGLUR1 IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625533","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMPA RECEPTOR IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL -ARUP","code_information":[{"code":"3028625534","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GABA BR IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625535","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CASPR2 IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625536","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LGI1 IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625537","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DPPX IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625538","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGLONS IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625539","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GABA AR IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028625540","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NMDA RECEPTOR IGG - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL -ARUP","code_information":[{"code":"3028625541","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLOMERULAR BASEMENT MEMBRANE IGG - ARUP","code_information":[{"code":"3028625542","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.51,"discounted_cash":290.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MUSCLE SPECIFIC KINASE (MUSK) IGG - ARUP","code_information":[{"code":"3028625545","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TITIN ANTIBODY - MYASTHENIA GRAVIS PANEL - ARUP","code_information":[{"code":"3028625546","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N METHYL D ASPARTATE (NMDA) RECEPTOR IGG WITH REFLEX - ARUP","code_information":[{"code":"3028625547","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARANEOPLASTIC ANTIBODIES REFLEX TITER & WB - ARUP","code_information":[{"code":"3028625548","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CV2.1 IGG IFA - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3028625549","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PCCA/ANNA IGG - PARANEOPLASTIC REFLEX PANEL - ARUP","code_information":[{"code":"3028625550","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI-PARIETAL CELL ANTIBODY","code_information":[{"code":"3028625551","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHOSPHOLIPASE A2 RECEPTOR IGG WITH REFLEX - ARUP","code_information":[{"code":"3028625552","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AMPA RECEPTOR IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625576","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CASPR2 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625577","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CV2.1 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625578","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DPPX IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625579","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GABA BR IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625580","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IGLON5 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625581","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LGI1 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625582","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MGLUR1 IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625583","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.67,"discounted_cash":106.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NMDA RECEPTOR IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625584","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PCCA/ANNA IGG - AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA PANEL CSF - ARUP","code_information":[{"code":"3028625585","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.88,"discounted_cash":88.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STRIATED MUSCLE AB - ACHR, TITIN, STM AB REFLEX PANEL - ARUP","code_information":[{"code":"3028625587","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86255","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUORESCENT ANTIBODY; TITER - ANTIMITOCHONDRIAL AB","code_information":[{"code":"3028625601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.02,"discounted_cash":143.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI-SMOOTH MUSCLE ANTIBODY TITER","code_information":[{"code":"3028625602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.88,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUORESCENT ANTIBODY; TITER - DSDNA IGG","code_information":[{"code":"3028625604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.03,"discounted_cash":89.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUORESCENT NONINFECTIOUS ANTIBODY - TITER - EACH ANTIBODY","code_information":[{"code":"3028625605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.61,"discounted_cash":184.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARIETAL CELL ANTIBODY TITER","code_information":[{"code":"3028625616","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.02,"discounted_cash":143.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUORESCENT ANTIBODY TITER - STRIATED MUSCLE","code_information":[{"code":"3028625627","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.99,"discounted_cash":60.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N METHYL D ASPARTATE (NMDA) RECEPTOR - ARUP","code_information":[{"code":"3028625628","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":184.61,"discounted_cash":184.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DOUBLE-STRANDED DNA (DSDNA) IGG IFA - ARUP","code_information":[{"code":"3028625634","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.03,"discounted_cash":89.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STRIATED MUSCLES IGG TITER - ARUP","code_information":[{"code":"3028625636","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86256","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.99,"discounted_cash":60.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGA","code_information":[{"code":"3028625802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN ANTIBODY (DEAMIDATED), IGG","code_information":[{"code":"3028625803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGA - CELIAC CASCADE SCREEN","code_information":[{"code":"3028625804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGA","code_information":[{"code":"3028625805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGA - CELIAC COMPREHENSIVE PANEL","code_information":[{"code":"3028625806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGG - CELIAC COMPREHENSIVE PANEL","code_information":[{"code":"3028625807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGA - GLIADIN PEPTIDE ANTIBODIES IGA AND IGG - ARUP","code_information":[{"code":"3028625808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGG - GLIADIN PEPTIDE ANTIBODIES IGA AND IGG - ARUP","code_information":[{"code":"3028625809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGA PEPTIDE ANTIBODIES - ARUP","code_information":[{"code":"3028625810","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGG","code_information":[{"code":"3028625811","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLIADIN IGG PEPTIDE ANTIBODIES - ARUP","code_information":[{"code":"3028625812","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86258","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CANCER ANTIGEN 15-3","code_information":[{"code":"3028630001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.46,"discounted_cash":20.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY, TUMOR ANTIGEN, CA 15-3 - CANCER ANTIGEN 27.29","code_information":[{"code":"3028630002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.36,"discounted_cash":57.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CANCER ANTIGEN 27.29 - ARUP","code_information":[{"code":"3028630004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86300","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.36,"discounted_cash":57.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CANCER ANTIGEN 19-9","code_information":[{"code":"3028630101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.0,"discounted_cash":69.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CANCER ANTIGIEN 19-9 BODY FLUID - ARUP","code_information":[{"code":"3028630103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86301","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.4,"discounted_cash":83.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CA 125","code_information":[{"code":"3028630401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86304","type":"HCPCS"}],"standard_charges":[{"gross_charge":219.27,"discounted_cash":219.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPIDIDYMIS PROTEIN 4","code_information":[{"code":"3028630501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86305","type":"HCPCS"}],"standard_charges":[{"gross_charge":237.56,"discounted_cash":237.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MONONUCLEOSIS SCREEN","code_information":[{"code":"3028630801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86308","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.05,"discounted_cash":171.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY TUMOR ANTIGEN - CHROMOGRANIN A","code_information":[{"code":"3028631601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.63,"discounted_cash":69.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEURON SPECIFIC ENOLASE","code_information":[{"code":"3028631602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.36,"discounted_cash":57.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHROMOGRANIN A - ARUP","code_information":[{"code":"3028631604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.63,"discounted_cash":69.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEURON SPECIFIC ENOLASE - ARUP","code_information":[{"code":"3028631605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.36,"discounted_cash":57.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYFRA 21-1 (CYTOKERATIN 19 FRAGMENT - ARUP","code_information":[{"code":"3028631606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86316","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.63,"discounted_cash":69.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - TETANUS ANTIBODY, IGG","code_information":[{"code":"3028631702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.77,"discounted_cash":138.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - STREP PNEUMONIAE ANTIBODY SEROTYPES","code_information":[{"code":"3028631704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - OTHER","code_information":[{"code":"3028631705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREUTZFELDT JACOB DISEASE CSF","code_information":[{"code":"3028631706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HAEMOPHILUS INFLUENZAE B ANTIBODY IGG","code_information":[{"code":"3028631707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - DIPHTHERIA","code_information":[{"code":"3028631711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY,INFECT AGENT,QUANT - TETANUS","code_information":[{"code":"3028631718","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CREUTZFELDT-JAKOB DISEASE - 14 3 3 PROTEIN CSF - ARUP","code_information":[{"code":"3028631721","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIPHTHERIA IGG - ARUP","code_information":[{"code":"3028631723","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 1 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631724","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 10A IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631725","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 11A IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631726","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 12F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631727","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 14 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631728","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 15B IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631729","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 17F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631730","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 18C IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631731","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 19A IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631732","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 19F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631733","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 2 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631734","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 20 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631735","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 22F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631736","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 23F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631737","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 3 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631738","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 33F IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631739","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 4 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631740","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 5 IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631741","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 6B IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631742","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 7F IGG (P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631743","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 8 IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631744","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 9N IGG (PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631745","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 9V IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 23 SEROTYPES - ARUP","code_information":[{"code":"3028631746","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TETANUS IGG - ARUP","code_information":[{"code":"3028631749","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":138.77,"discounted_cash":138.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 1 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631751","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 12F IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631752","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 14 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631753","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 18C IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631754","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 19F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631755","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 23F IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631756","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 3 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631757","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 4 IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631758","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 5 IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631759","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 6B IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631760","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 7F IGG (P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631761","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 8 IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631762","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 9N IGG (PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631763","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMO SEROTYPE 9V IGG (P7,P13,PNX) - PNEUMOCOCCAL AB 14 SEROTYPES - ARUP","code_information":[{"code":"3028631764","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86317","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.37,"discounted_cash":121.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOASSAY GEL DIFFUSION EACH ANTIGEN OR ANTIBODY QUAL","code_information":[{"code":"3028633103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HYPERSENSITIVITY PNEUMONITIS 2 PANEL","code_information":[{"code":"3028633104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC S VIRIDIS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028633105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T CANDIDUS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028633106","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A PULLULANS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC M FAENI AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PIGEON SERUM AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC S VIRIDIS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T CANDIDUS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028633111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86331","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.47,"discounted_cash":67.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - BETA 2 TRANSFERRIN","code_information":[{"code":"3028633401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.89,"discounted_cash":73.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS - EACH ANALYTE","code_information":[{"code":"3028633402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.94,"discounted_cash":45.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION ADD ON SERUM","code_information":[{"code":"3028633408","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.94,"discounted_cash":45.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION SERUM","code_information":[{"code":"3028633409","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.94,"discounted_cash":45.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION SERUM - ARUP","code_information":[{"code":"3028633413","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86334","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.25,"discounted_cash":47.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF - MONOCLONAL PROTEIN URINE","code_information":[{"code":"3028633502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":238.04,"discounted_cash":238.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNFIX E-PHORSIS/URINE/CSF - EACH ANALYTE","code_information":[{"code":"3028633503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.55,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION ELECTROPHORESIS 24 HOUR URINE","code_information":[{"code":"3028633504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.55,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION - IMMUNOFIXATION URINE - ARUP","code_information":[{"code":"3028633505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.55,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION URINE ADD ON","code_information":[{"code":"3028633506","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.55,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION URINE","code_information":[{"code":"3028633507","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":293.55,"discounted_cash":293.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFIXATION - IMMUNOFIXATION WITH FREE LIGHT CHAINS URINE - ARUP","code_information":[{"code":"3028633509","type":"CDM"},{"code":"0301","type":"RC"},{"code":"86335","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.58,"discounted_cash":50.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INHIBIN A - ADDITIONAL CHARGE","code_information":[{"code":"3028633601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86336","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.14,"discounted_cash":21.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSULIN ANTIBODIES - INSULIN ANTIBODY","code_information":[{"code":"3028633701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.16,"discounted_cash":59.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSULIN ANTIBODY - ARUP","code_information":[{"code":"3028633702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86337","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.16,"discounted_cash":59.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTRINSIC FACTOR BLOCKING ANTIBODY - ARUP","code_information":[{"code":"3028634001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86340","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.03,"discounted_cash":25.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ISLET CELL ANTIBODY - ANTI-ISLET CELL AB","code_information":[{"code":"3028634101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.92,"discounted_cash":57.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE CSF","code_information":[{"code":"3028634102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.22,"discounted_cash":86.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE 65","code_information":[{"code":"3028634104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.22,"discounted_cash":86.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ISLET CELL CYTOPLASMIC IGG - ARUP","code_information":[{"code":"3028634105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.92,"discounted_cash":57.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE-AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL-ARUP","code_information":[{"code":"3028634107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.22,"discounted_cash":86.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ISLET ANTIGEN 2 (IA-2) AUTOANTIBODY - ARUP","code_information":[{"code":"3028634108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.92,"discounted_cash":57.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE-AUTOIMMUNE ENCEPHALOPATHY/DEMENTIA CSF-ARUP","code_information":[{"code":"3028634111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.22,"discounted_cash":86.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GLUTAMIC ACID DECARBOXYLASE ANTIBODY - ARUP","code_information":[{"code":"3028634112","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86341","type":"HCPCS"}],"standard_charges":[{"gross_charge":86.22,"discounted_cash":86.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CELLULAR FUNCTION STIMULATION AND BIOMARKER ASSAY","code_information":[{"code":"3028635201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86352","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.02,"discounted_cash":195.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC B CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.13,"discounted_cash":296.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC B CELLS, TOTAL - B CELL CD20 EXPRESSION BY FLOW, QUANT - ARUP","code_information":[{"code":"3028635503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86355","type":"HCPCS"}],"standard_charges":[{"gross_charge":296.13,"discounted_cash":296.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CD57+ MONONUCLEAR CELL ANTIGEN QUANTITATIVE BY FLOW CYTOMETRY - ARUP","code_information":[{"code":"3028635602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86356","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.58,"discounted_cash":88.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NATURAL KILLER CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.48,"discounted_cash":514.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NATURAL KILLER CELLS, TOTAL COUNT - LYMPHOCYTE SUBSET PANEL 5 - ARUP","code_information":[{"code":"3028635702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86357","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.48,"discounted_cash":514.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T CELLS TOTAL COUNT","code_information":[{"code":"3028635901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.46,"discounted_cash":343.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T CELL COUNT - LYMPHOCYTE SUBSET PANEL 3 - ARUP","code_information":[{"code":"3028635902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86359","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.27,"discounted_cash":46.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 3 - ARUP","code_information":[{"code":"3028636001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.14,"discounted_cash":60.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CD4/CD8 COUNT","code_information":[{"code":"3028636004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.26,"discounted_cash":46.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 3 - ARUP","code_information":[{"code":"3028636005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.14,"discounted_cash":60.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CD4/CD8 COUNT - LYMPHOCYTE SUBSET PANEL 4 - ARUP","code_information":[{"code":"3028636006","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86360","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.14,"discounted_cash":60.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC T CELL ABSOLUTE COUNT - T-HELPER CELLS (CD4) COUNT","code_information":[{"code":"3028636101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.02,"discounted_cash":195.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LYMPHOCYTE SUBSET PANEL 2 - CD4 PERCENT AND ABSOLUTE - ARUP","code_information":[{"code":"3028636102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86361","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.02,"discounted_cash":195.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOG-IGG IMMUNOFLUOR - AUTOIMMUNE ENCEPHALITIS EXTENDED PANEL - ARUP","code_information":[{"code":"3028636201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.63,"discounted_cash":380.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELIN OLIGODENTROCYTE GLYCOPROTEIN (MOG) IGG WITH REFLEX - ARUP","code_information":[{"code":"3028636202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86362","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.63,"discounted_cash":380.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGG - CELIAC COMPREHENSIVE PANEL","code_information":[{"code":"3028636404","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - CELIAC COMPREHENSIVE PANEL","code_information":[{"code":"3028636405","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.78,"discounted_cash":31.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE TRANSGLUTAMINASE IGA - CELIAC DISEASE REFLEX CASCADE - ARUP","code_information":[{"code":"3028636407","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86364","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.5,"discounted_cash":31.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MUSCLE-SPECIFIC KINASE (MUSK) IGG BY CBA-IFA WITH REFLEX - ARUP","code_information":[{"code":"3028636602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86366","type":"HCPCS"}],"standard_charges":[{"gross_charge":774.38,"discounted_cash":774.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROSOMAL ANTIBODY - THYROID PEROXIDASE ANTIBODY","code_information":[{"code":"3028637602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.9,"discounted_cash":160.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIVER KIDNEY MICROSOMAL ANTIBODY","code_information":[{"code":"3028637604","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.12,"discounted_cash":48.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LIVER KIDNEY MICROSOME IGG - ARUP","code_information":[{"code":"3028637605","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.9,"discounted_cash":160.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROID PEROXIDASE (TPO) ANTIBODY - THYROID ANTIBODIES - ARUP","code_information":[{"code":"3028637606","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86376","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.9,"discounted_cash":160.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MITOCHONDRIAL M2 ANTIBODIES","code_information":[{"code":"3028638105","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86381","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.15,"discounted_cash":70.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RABIES ANTIBODY SCREEN - ARUP","code_information":[{"code":"3028638203","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86382","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.24,"discounted_cash":354.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARTICLE AGGLUTINATION TEST, SCREEN - CRYPTOCOCCAL ANTIGEN","code_information":[{"code":"3028640302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86403","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.61,"discounted_cash":22.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARTICLE AGGLUTINATION TEST, TITER - CRYPTOCOCCUS ANTIGEN TITER","code_information":[{"code":"3028640602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86406","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.63,"discounted_cash":14.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RHEUMATOID FACTOR TEST - RHEUMATOID FACTOR SCREEN","code_information":[{"code":"3028643001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86430","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":96.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RHEUMATOID FACTOR, QUANT - RHEUMATOID FACTOR","code_information":[{"code":"3028643101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.46,"discounted_cash":37.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RHEUMATOID FACTOR","code_information":[{"code":"3028643104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.46,"discounted_cash":37.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RHEUMATOID FACTOR TITER REFLEX","code_information":[{"code":"3028643107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.46,"discounted_cash":37.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RHEUMATOID FACTOR - LUPUS COMPREHENSIVE REFLEX PANEL - ARUP","code_information":[{"code":"3028643108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86431","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.46,"discounted_cash":37.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TB TEST CELL MEDIATED ANTIGEN RESPONSE,GAMMA INTERFRON","code_information":[{"code":"3028648001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86480","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.0,"discounted_cash":211.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VDRL CSF","code_information":[{"code":"3028659201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.44,"discounted_cash":111.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RPR QUAL","code_information":[{"code":"3028659202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.44,"discounted_cash":111.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VDRL WITH REFLEX TO TITER, SERUM - ARUP","code_information":[{"code":"3028659208","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.44,"discounted_cash":111.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RAPID PLASMA REAGIN (RPR) QUAL","code_information":[{"code":"3028659211","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86592","type":"HCPCS"}],"standard_charges":[{"gross_charge":111.44,"discounted_cash":111.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RPR TITER","code_information":[{"code":"3028659301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86593","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.59,"discounted_cash":155.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VOLTAGE GATED CALCIUM CHANNEL AB","code_information":[{"code":"3028659601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.72,"discounted_cash":50.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VOLTAGE GATED CALCIUM CHANNEL ANTIBODY - ARUP","code_information":[{"code":"3028659602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86596","type":"HCPCS"}],"standard_charges":[{"gross_charge":50.72,"discounted_cash":50.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASPERGILLUS ANTIBODY - ASPERGILLUS ABS","code_information":[{"code":"3028660601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.56,"discounted_cash":43.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HYPERSENSITIVITY PNEUMONITIS 1 - IMMUNOASSAY ANTIBODY - A FUMIGATUS #1, A FUMIGATUS #6","code_information":[{"code":"3028660602","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HYPERSENSITIVITY PNEUOMONITIS 2 -  IMMUNOASSAY ANTIBODY - A FLAVUS #2, A FUMIGATUS #2, A FUMIGATUS #3","code_information":[{"code":"3028660603","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A FLAVUS AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660608","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A FUMIGATUS #2 AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660609","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A FUMIGATUS #3 AB PRECIPITIN - HYPERSENSITIVITY PNEUMONITIS 2 - ARUP","code_information":[{"code":"3028660610","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASPERGILLUS ANTIBODY BY IMMUNODIFFUSION - ARUP","code_information":[{"code":"3028660612","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.56,"discounted_cash":43.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A FUMIGATUS #1 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660613","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A FUMIGATUS #6 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660614","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A FLAVUS AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660615","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A FUMIGATUS #2 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660616","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC A FUMIGATUS #3 AB PRECIPITIN - HYPER PNEUMO EXTENDED PANEL - ARUP","code_information":[{"code":"3028660617","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86606","type":"HCPCS"}],"standard_charges":[{"gross_charge":49.78,"discounted_cash":49.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA HENSELAE ANTIBODY","code_information":[{"code":"3028661102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":14.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA HENSELAE IGG - ARUP","code_information":[{"code":"3028661104","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":14.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA HENSELAE IGM - ARUP","code_information":[{"code":"3028661107","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":14.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA QUINTANA IGM - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.67,"discounted_cash":33.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA HENSELAE IGG - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661109","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":14.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA QUINTANA IGG - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661110","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.67,"discounted_cash":33.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA HENSELAE IGM - BARTONELLA AB PANEL - ARUP","code_information":[{"code":"3028661111","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86611","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.57,"discounted_cash":14.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BORDETELLA PERTUSSIS IGG IMMUNOBLOT","code_information":[{"code":"3028661504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86615","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.3,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LYME DISEASE ANTIBODY, CONFIRMATORY - LYME DISEASE, WESTERN BLOT","code_information":[{"code":"3028661701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BORRELIA BURGDORFERI ANTIBODY IMMUNOBLOT CSF","code_information":[{"code":"3028661704","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.36,"discounted_cash":54.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BORRELIA BURGDORFERI IMMUNOBLOT IGG","code_information":[{"code":"3028661705","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.7,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC B. BURGDORFERI (LYME) IGM CSF","code_information":[{"code":"3028661706","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.36,"discounted_cash":54.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC B. BURGDORFERI (LYME) IGG - ARUP","code_information":[{"code":"3028661707","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.7,"discounted_cash":42.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BORRELIA BUGDORFERI/LYME IGG BY IMMUNOBLOT - LYME ANTIBODIES - ARUP","code_information":[{"code":"3028661708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BORRELIA BUGDORFERI/LYME IGM BY IMMUNOBLOT - LYME ANTIBODIES - ARUP","code_information":[{"code":"3028661709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86617","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC B BURGDORFERI ANTIBODY - LYME STANDARD 2-TIER, 1ST TIER - ARUP","code_information":[{"code":"3028661802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86618","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.15,"discounted_cash":19.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRUCELLA SPECIES ANTIBODY TOTAL - ARUP","code_information":[{"code":"3028662202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86622","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.74,"discounted_cash":12.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C PSITTACI IGG TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.67,"discounted_cash":39.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C PSITTACI IGG TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663102","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86631","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.02,"discounted_cash":39.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C PSITTACI IGM TITER - CHLAMYDIA ANTIBODY PANEL IGG IGM - ARUP","code_information":[{"code":"3028663201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86632","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.98,"discounted_cash":40.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CMV ANTIBODY - CMV IGG","code_information":[{"code":"3028664401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.67,"discounted_cash":39.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGG - CMV ANTIBODIES IGG IGM - ARUP","code_information":[{"code":"3028664403","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86644","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.67,"discounted_cash":39.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CMV ANTIBODY, IGM - CMV IGM","code_information":[{"code":"3028664501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":19.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGM - CMV ANTIBODIES IGG IGM - ARUP","code_information":[{"code":"3028664503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":19.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) IGM - ARUP","code_information":[{"code":"3028664505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86645","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":19.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALIFORNIA ENCEPHALITIS IGM CSF - ARBOVIRUS PANEL, IGM CSF - ARUP","code_information":[{"code":"3028665108","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86651","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.71,"discounted_cash":35.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EASTERN EQUINE ENCEPHALITIS IGM CSF - ARBOVIRUS PANEL IGM CSF - ARUP","code_information":[{"code":"3028665209","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86652","type":"HCPCS"}],"standard_charges":[{"gross_charge":53.14,"discounted_cash":53.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ST LOUIS ENCEPHALITIS IGM CSF - ARBOVIRUS PANEL IGM CSF - ARUP","code_information":[{"code":"3028665309","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86653","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.91,"discounted_cash":72.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WESTERN EQUINE ENCEPHALITIS IGM CSF-ARBOVIRUS PANEL IGM CSF - ARUP","code_information":[{"code":"3028665409","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86654","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.71,"discounted_cash":35.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENTEROVIRUS ANTIBODY - ENTEROVIRUS PANEL COXSACKIE","code_information":[{"code":"3028665803","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.95,"discounted_cash":35.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POLIO VIRUS TYPE 1 - POLIOVIRUS ANTIBODIES TYPES 1 AND 3 - ARUP","code_information":[{"code":"3028665811","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.5,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POLIO VIRUS TYPE 3 - POLIOVIRUS ANTIBODIES TYPES 1 AND 3 - ARUP","code_information":[{"code":"3028665812","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86658","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.5,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN BARR VIRUS EARLY IGG","code_information":[{"code":"3028666301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.61,"discounted_cash":16.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EBV - EARLY IGG - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666302","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86663","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.61,"discounted_cash":16.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN-BARR NUCLEAR ANTIGEN - EPSTEIN-BARR VIRUS NUCLEAR ANTIGEN AB","code_information":[{"code":"3028666401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.77,"discounted_cash":18.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EBV - NUCLEAR AG, IGG - EPSTEIN-BARR VIRUS ANTIBODY PANEL 1 - ARUP","code_information":[{"code":"3028666402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86664","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.77,"discounted_cash":18.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN-BARR CAPSID VCA, IGG","code_information":[{"code":"3028666501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":52.5,"discounted_cash":52.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN-BARR CAPSID VCA, IGM","code_information":[{"code":"3028666502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGG - EBV ANTIBODY PANEL","code_information":[{"code":"3028666503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.0,"discounted_cash":25.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN-BARR VIRUS VCA, IGG","code_information":[{"code":"3028666505","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":20.0,"discounted_cash":20.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN BARR VIRUS AB TO VIRAL CAPSID AG, IGM - ARUP","code_information":[{"code":"3028666512","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.0,"discounted_cash":63.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN BARR VIRUS CAPSID VCA IGM - EBV ANTIBODY PANEL","code_information":[{"code":"3028666520","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86665","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.0,"discounted_cash":60.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EHRLICHIA ANTIBODY - EHRLICHIA CHAFFEENSIS PANEL","code_information":[{"code":"3028666601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86666","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.48,"discounted_cash":201.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FUNGUS, ANTIBODY - SACCHAROMYCES CEREVISIAE ANTIBODIES, IGG AND IGA","code_information":[{"code":"3028667112","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.86,"discounted_cash":51.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC S CEREVISIAE IGG/IGA - INFLAMMATORY BOWEL DISEASE PANEL - ARUP","code_information":[{"code":"3028667113","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86671","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.86,"discounted_cash":51.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HELICOBACTER PYLORI - HELICOBACTER PYLORI IGG","code_information":[{"code":"3028667702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":91.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HELICOBACTER PYLORI IGG","code_information":[{"code":"3028667703","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86677","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.25,"discounted_cash":91.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HELMINTH, ANTIBODY - CYSTICERCOSIS ANTIBODY, IGG","code_information":[{"code":"3028668201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.21,"discounted_cash":28.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HELMINTH, ANTIBODY - ECHINOCOCCUS ANTIBODY, IGG","code_information":[{"code":"3028668202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":29.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STRONGYLOIDES IGG - ARUP","code_information":[{"code":"3028668207","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86682","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.58,"discounted_cash":29.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HTLV/HIV CONFIRMATORY TEST - HIV-1 WESTERN BLOT","code_information":[{"code":"3028668901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86689","type":"HCPCS"}],"standard_charges":[{"gross_charge":118.3,"discounted_cash":118.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS, DELTA AGENT - HEPATITIS DELTA VIRUS","code_information":[{"code":"3028669201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86692","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.15,"discounted_cash":73.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC TYPE IGG AB","code_information":[{"code":"3028669401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.31,"discounted_cash":92.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX TEST, UNSPECIFIED TYPE - HSV NON-SPECIFIC ANTIBODY","code_information":[{"code":"3028669402","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.6,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) 1/2 COMBINED IGG - ARUP","code_information":[{"code":"3028669408","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.31,"discounted_cash":92.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) TYPE 1/2 IGM - ARUP","code_information":[{"code":"3028669409","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.6,"discounted_cash":47.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX VIRUS(HSV) 1/2 IGG W/ RFLX TYPE 1/2 GLYCO G SPECIFIC-ARUP","code_information":[{"code":"3028669412","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86694","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.31,"discounted_cash":92.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX TEST, TYPE 1 IGG","code_information":[{"code":"3028669501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.77,"discounted_cash":74.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX 1 GLYCOPROTEIN G AB IGG","code_information":[{"code":"3028669503","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.63,"discounted_cash":43.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX VIRUS TYPE 1 IGG - HSV 1 AND 2 ANTIBODY IGG","code_information":[{"code":"3028669508","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.77,"discounted_cash":74.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV TYPE 1 IGG - HSV 1 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669509","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86695","type":"HCPCS"}],"standard_charges":[{"gross_charge":43.63,"discounted_cash":43.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV TYPE 2 IGG - HSV 2 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.77,"discounted_cash":74.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV 2 GLYCOPROTEIN G IGG - ARUP","code_information":[{"code":"3028669609","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.77,"discounted_cash":74.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX VIRUS TYPE 2 IGG - HSV 1 AND 2 ANTIBODY IGG","code_information":[{"code":"3028669615","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86696","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.77,"discounted_cash":74.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HISTOPLASMA - HISTOPLASMA ANTIBODIES","code_information":[{"code":"3028669801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86698","type":"HCPCS"}],"standard_charges":[{"gross_charge":31.87,"discounted_cash":31.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV-1 - HIV 1 ANTIBODY EIA","code_information":[{"code":"3028670101","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":25.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV 1 - HIV 1/2 AB DIFF, SUPPLEMENTAL - ARUP","code_information":[{"code":"3028670103","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86701","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.74,"discounted_cash":25.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV-2 - HIV-2 ANTIBODIES","code_information":[{"code":"3028670201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.09,"discounted_cash":92.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV 2 - HIV 1/2 AB DIFF, SUPPLEMENTAL - ARUP","code_information":[{"code":"3028670202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86702","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.09,"discounted_cash":92.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B CORE ANTIBODY TOTAL","code_information":[{"code":"3028670401","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86704","type":"HCPCS"}],"standard_charges":[{"gross_charge":34.88,"discounted_cash":34.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B CORE ANTIBODY IGM","code_information":[{"code":"3028670501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86705","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.2,"discounted_cash":84.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B SURFACE ANTIBODY","code_information":[{"code":"3028670601","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86706","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.48,"discounted_cash":153.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS BE AB TEST - HEPATITIS B E ANTIBODY","code_information":[{"code":"3028670701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B E VIRUS ANTIBODY - ARUP","code_information":[{"code":"3028670702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86707","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.75,"discounted_cash":22.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS A ANTIBODY TOTAL","code_information":[{"code":"3028670801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86708","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.87,"discounted_cash":35.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS A IGM","code_information":[{"code":"3028670901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86709","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.0,"discounted_cash":38.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEPTOSPIRA - LEPTOSPIRA ANTIBODY","code_information":[{"code":"3028672001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.46,"discounted_cash":97.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEPTOSPIRA IGM - ARUP","code_information":[{"code":"3028672002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86720","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.46,"discounted_cash":97.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MUMPS - MUMPS IGG ANTIBODY","code_information":[{"code":"3028673501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MUMPS - MUMPS IGM ANTIBODY","code_information":[{"code":"3028673502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":13.66,"discounted_cash":13.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MUMPS IGG - QUANTITATIVE","code_information":[{"code":"3028673504","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86735","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.77,"discounted_cash":37.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYCOPLASMA - MYCOPLASMA PNEUMONIAE ANTIBODY, IGM","code_information":[{"code":"3028673801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.27,"discounted_cash":72.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGG","code_information":[{"code":"3028673802","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.27,"discounted_cash":72.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGM - MYCOPLASMA PNEUMONIAE ANTIBODY G/M - ARUP","code_information":[{"code":"3028673805","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.27,"discounted_cash":72.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYCOPLASMA PNEUMONIAE IGG - MYCOPLASMA PNEUMONIAE ANTIBODY G/M - ARUP","code_information":[{"code":"3028673806","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86738","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.27,"discounted_cash":72.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRYPANOSOMA CRUZI IGG - ARUP","code_information":[{"code":"3028675312","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86753","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.3,"discounted_cash":27.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RICKETTSIA - RICKETTSIA RICKETTSII ANTIBODY","code_information":[{"code":"3028675701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RICKETTSIA - RICKETTSIA TYPHI (TYPHUS FEVER) ANTIBODY","code_information":[{"code":"3028675702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGG - ARUP","code_information":[{"code":"3028675709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGG - ROCKY MOUNTAIN SPOT FEVER IGG IGM - ARUP","code_information":[{"code":"3028675710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ROCKY MOUNTAIN SPOT FEVER IGM - ROCKY MOUNTAIN SPOT FEVER IGG IGM - ARUP","code_information":[{"code":"3028675711","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ROCKY MOUNTAIN SPOTTED FEVER IGM - ARUP","code_information":[{"code":"3028675712","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TYPHUS FEVER IGM - ARUP","code_information":[{"code":"3028675713","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86757","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.66,"discounted_cash":23.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RUBELLA - RUBELLA ANTIBODY, IGM","code_information":[{"code":"3028676201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":41.65,"discounted_cash":41.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RUBELLA IGG QUANTITATIVE","code_information":[{"code":"3028676202","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86762","type":"HCPCS"}],"standard_charges":[{"gross_charge":329.41,"discounted_cash":329.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RUBEOLA ANTIBODY IGG","code_information":[{"code":"3028676501","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RUBEOLA - RUBEOLA ANTIBODY, IGM","code_information":[{"code":"3028676502","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86765","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.5,"discounted_cash":35.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SARS-COV-2 COVID-19 ANTIBODY - COVID-19 ANTIBODY TITER, IGG AND IGM","code_information":[{"code":"3028676901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.33,"discounted_cash":182.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COVID-19 SARS-COV-2 ANTIBODY","code_information":[{"code":"3028676902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.33,"discounted_cash":182.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COVID-19 SARS-COV-2 IGG SPIKE SEMI-QUANTITATIVE BY CIA - ARUP","code_information":[{"code":"3028676903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.33,"discounted_cash":182.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COVID-19 SARS-COV-2 IGG QUALITATIVE - ARUP","code_information":[{"code":"3028676905","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86769","type":"HCPCS"}],"standard_charges":[{"gross_charge":182.33,"discounted_cash":182.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOXOPLASMA - TOXOPLASMA GONDII IGG ANTIBODY","code_information":[{"code":"3028677701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86777","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.67,"discounted_cash":39.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOXOPLASMA, IGM - TOXOPLASMA GONDII ANTIBODY, IGM","code_information":[{"code":"3028677801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86778","type":"HCPCS"}],"standard_charges":[{"gross_charge":12.81,"discounted_cash":12.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TREPONEMA PALLIDUM CONFIRMATION","code_information":[{"code":"3028678001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.13,"discounted_cash":146.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTIBODY TREPONEMA PALLIDUM - FTA ANTIBODIES, IGG AND IGM","code_information":[{"code":"3028678002","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.13,"discounted_cash":146.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TREPONEMA PALLIDUM ANTIBODY","code_information":[{"code":"3028678008","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.13,"discounted_cash":146.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TREPONEMA PALLIDUM CONFIRMATION","code_information":[{"code":"3028678010","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.13,"discounted_cash":146.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TREPONEMA PALLIDUM IGG BY IFA (FTA-ABS) - ARUP","code_information":[{"code":"3028678013","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86780","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.13,"discounted_cash":146.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VARICELLA ZOSTER IGG","code_information":[{"code":"3028678701","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VARICELLA-ZOSTER - VARICELLA ZOSTER IGM","code_information":[{"code":"3028678702","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.0,"discounted_cash":44.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VARICELLA ZOSTER IGM - ARUP","code_information":[{"code":"3028678708","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VARICELLA ZOSTER IGM - VARICELLA ZOSTER IGG AND IGM - ARUP","code_information":[{"code":"3028678709","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.93,"discounted_cash":15.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VARICELLA ZOSTER IGG - VZ IGG AND IGM - ARUP","code_information":[{"code":"3028678710","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86787","type":"HCPCS"}],"standard_charges":[{"gross_charge":37.28,"discounted_cash":37.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WEST NILE VIRUS AB, IGM - WEST NILE ANTIBODIES, IGG AND IGM","code_information":[{"code":"3028678801","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":79.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENCEPHALITIS PANEL WEST NILE VIRUS ANTIBODY IGM CSF","code_information":[{"code":"3028678804","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":79.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WEST NILE VIRUS IGM - WEST NILE VIRUS CSF - ARUP","code_information":[{"code":"3028678807","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":79.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WEST NILE ENCEPHALITIS CSF - ARBOVIRUS PANEL IGM CSF - ARUP","code_information":[{"code":"3028678808","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":79.65,"discounted_cash":79.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WEST NILE VIRUS IGM CSF - ARUP","code_information":[{"code":"3028678809","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86788","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.97,"discounted_cash":58.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WEST NILE VIRUS ANTIBODY - WEST NILE VIRUS ANTIBODY, IGG","code_information":[{"code":"3028678901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.1,"discounted_cash":39.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENCEPHALITIS PANEL WEST NILE VIRUS ANTIBODY IGG CSF","code_information":[{"code":"3028678902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.1,"discounted_cash":39.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WEST NILE VIRUS IGG - WNV CSF - ARUP","code_information":[{"code":"3028678906","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86789","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.1,"discounted_cash":39.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTIBODY DENGUE FEVER IGG","code_information":[{"code":"3028679005","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.91,"discounted_cash":28.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTIBODY HERPES VIRUS 6 IGG","code_information":[{"code":"3028679008","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.71,"discounted_cash":140.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTIBODY DENGUE FEVER IGM","code_information":[{"code":"3028679011","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.05,"discounted_cash":96.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DENGUE FEVER IGM - ARUP","code_information":[{"code":"3028679030","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.91,"discounted_cash":28.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES VIRUS 6 IGG - ARUP","code_information":[{"code":"3028679033","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.71,"discounted_cash":140.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES VIRUS 6 IGM - ARUP","code_information":[{"code":"3028679034","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.71,"discounted_cash":140.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HTLV I AND II ANTIBODY WITH REFLEX - ARUP","code_information":[{"code":"3028679035","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86790","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.22,"discounted_cash":18.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB","code_information":[{"code":"3028680001","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":46.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROGLOBULIN ANTIBODY - ANTI-THYROGLOBULIN AB WITH REFLEX TO THYROGLOBULIN","code_information":[{"code":"3028680003","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.72,"discounted_cash":63.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTI THYROGLOBULIN (ATHYG) ANTIBODY","code_information":[{"code":"3028680004","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":46.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROGLOBULIN ANTIBODY WITH REFLEX - ARUP","code_information":[{"code":"3028680007","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":46.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROGLOBULIN ANTIBODY - THYROID ANTIBODIES - ARUP","code_information":[{"code":"3028680008","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86800","type":"HCPCS"}],"standard_charges":[{"gross_charge":46.05,"discounted_cash":46.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS C ANTIBODY - HEPATITIS PANEL ACUTE","code_information":[{"code":"3028680301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.08,"discounted_cash":109.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS C ANTIBODY BY CIA WITH REFLEX - ARUP","code_information":[{"code":"3028680306","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.04,"discounted_cash":121.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS C ANTIBODY WITH REFLEX HCV PCR- ARUP","code_information":[{"code":"3028680311","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86803","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.08,"discounted_cash":109.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA TYPING, A,B,OR C /SINGLE - HLA-B27 ANTIGEN","code_information":[{"code":"3028681201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86812","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.9,"discounted_cash":186.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA TYPING, A,B,OR C /MULTI - HLA A AND B PHENOTYPE","code_information":[{"code":"3028681301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86813","type":"HCPCS"}],"standard_charges":[{"gross_charge":284.41,"discounted_cash":284.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA AB ID CLASS I HD","code_information":[{"code":"3028683201","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86832","type":"HCPCS"}],"standard_charges":[{"gross_charge":2325.0,"discounted_cash":2325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA AB ID CLASS II HD","code_information":[{"code":"3028683301","type":"CDM"},{"code":"0302","type":"RC"},{"code":"86833","type":"HCPCS"}],"standard_charges":[{"gross_charge":2325.0,"discounted_cash":2325.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRICHROME STAIN - OVA AND PARASITE EXAM","code_information":[{"code":"3028720902","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.32,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OVA AND PARASITE COMPLEX STAIN - O&P EXAM BODY FLUID OR URINE - ARUP","code_information":[{"code":"3028720903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87209","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.32,"discounted_cash":103.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV1/2 ANTIBODY/ANTIGEN SCREEN","code_information":[{"code":"3028738901","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.6,"discounted_cash":69.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV 1 & 2 ANTIBODY/ANTIGEN WITH REFLEX DIFF -ARUP","code_information":[{"code":"3028738903","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.38,"discounted_cash":39.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV 1 & 2 ANTIGEN/ANTIBODY WITH REFLEX CIA - ARUP","code_information":[{"code":"3028738906","type":"CDM"},{"code":"0302","type":"RC"},{"code":"87389","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.17,"discounted_cash":73.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SARS COV2 2019 DNA RNA AMP HIGH THROUGHPUT","code_information":[{"code":"302U000301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"U0003","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.2,"discounted_cash":295.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD SMEAR,MICRO EXAM,MANUAL DIFF WBC - MANUAL DIFFERENTIAL","code_information":[{"code":"3058500701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.24,"discounted_cash":267.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MANUAL DIFFERENTIAL","code_information":[{"code":"3058500702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85007","type":"HCPCS"}],"standard_charges":[{"gross_charge":267.24,"discounted_cash":267.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD SMEAR,MICRO EXAM - SLIDE REVIEW","code_information":[{"code":"3058500801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85008","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.34,"discounted_cash":11.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMATOCRIT","code_information":[{"code":"3058501401","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.82,"discounted_cash":62.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMATOCRIT - POCT HEMATOCRIT","code_information":[{"code":"3058501404","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85014","type":"HCPCS"}],"standard_charges":[{"gross_charge":60.68,"discounted_cash":60.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMOGLOBIN","code_information":[{"code":"3058501801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85018","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.64,"discounted_cash":69.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COMPLETE CBC & AUTO WBC DIFF","code_information":[{"code":"3058502501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85025","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.0,"discounted_cash":338.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CBC","code_information":[{"code":"3058502701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85027","type":"HCPCS"}],"standard_charges":[{"gross_charge":129.37,"discounted_cash":129.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RETICULOCYTE COUNT, AUTO - RETICULOCYTES","code_information":[{"code":"3058504501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85045","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.13,"discounted_cash":119.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RETICULOCYTE COUNT, AUTO, W CELL PARAM - HEMOGLOBIN (PG) IN RETIC","code_information":[{"code":"3058504601","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85046","type":"HCPCS"}],"standard_charges":[{"gross_charge":214.6,"discounted_cash":214.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEUKOCYTE (WBC) COUNT - EOSINOPHIL COUNT","code_information":[{"code":"3058504802","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":112.46,"discounted_cash":112.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEUKOCYTE (WBC) COUNT - WHITE BLOOD COUNT","code_information":[{"code":"3058504803","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85048","type":"HCPCS"}],"standard_charges":[{"gross_charge":62.82,"discounted_cash":62.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELET COUNT","code_information":[{"code":"3058504902","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85049","type":"HCPCS"}],"standard_charges":[{"gross_charge":51.75,"discounted_cash":51.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RETICULATED PLATELET ASSAY","code_information":[{"code":"3058505501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85055","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.44,"discounted_cash":103.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERIPHERAL BLOOD SMEAR INTERPRETATION","code_information":[{"code":"3058506001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85060","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.38,"discounted_cash":143.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BONE MARROW,SMEAR INTERPRETATION - BONE MARROW SMEAR INTERP","code_information":[{"code":"3058509703","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85097","type":"HCPCS"}],"standard_charges":[{"gross_charge":277.85,"discounted_cash":277.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT FACTOR II PROTHROM SPEC - FACTOR 2 ACTIVITY","code_information":[{"code":"3058521001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 2 ACTIVITY","code_information":[{"code":"3058521002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85210","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOC CLOT FACTOR V TEST - FACTOR 5 ACTIVITY","code_information":[{"code":"3058522001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85220","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT FACTOR VII PROCONVERTIN - FACTOR 7 ACTIVITY","code_information":[{"code":"3058523001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 7 ACTIVITY","code_information":[{"code":"3058523002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85230","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 8 ACTIVITY","code_information":[{"code":"3058524001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85240","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT FACTOR VIII VW RISTOCTN - FACTOR VIII RISTOCETIN COFACTR","code_information":[{"code":"3058524501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.81,"discounted_cash":209.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VON WILLEBRAND RISTOCETIN FACTOR ACIVITY - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524503","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85245","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.81,"discounted_cash":209.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT FACTOR VIII VW ANTIGEN - VON WILLEBRAND ANTIGEN","code_information":[{"code":"3058524603","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.05,"discounted_cash":70.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VON WILLEBRAND FACTOR ANTIGEN - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524605","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85246","type":"HCPCS"}],"standard_charges":[{"gross_charge":70.05,"discounted_cash":70.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT FACTOR VIII VWF MULTIMETRIC ANALYSIS - VON WILLEBRAND MULTIMERIC PANEL(ARUP)","code_information":[{"code":"3058524702","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85247","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.37,"discounted_cash":205.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT FACTOR IX PTC/CHRSTMAS - FACTOR 9 ACTIVITY","code_information":[{"code":"3058525001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 9 ACTIVITY","code_information":[{"code":"3058525002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85250","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT FACTOR X STUART-POWER - FACTOR 10 ACTIVITY","code_information":[{"code":"3058526001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85260","type":"HCPCS"}],"standard_charges":[{"gross_charge":68.42,"discounted_cash":68.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT FACTOR XI PTA - FACTOR 11 ACTIVITY","code_information":[{"code":"3058527001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 11 ACTIVITY","code_information":[{"code":"3058527002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85270","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 12 ACTIVITY","code_information":[{"code":"3058528002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85280","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 13 SOLUBILITY SCREEN","code_information":[{"code":"3058529101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85291","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.74,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTITHROMBIN III","code_information":[{"code":"3058530001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85300","type":"HCPCS"}],"standard_charges":[{"gross_charge":26.06,"discounted_cash":26.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANTITHROMBIN III ANTIGEN","code_information":[{"code":"3058530101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85301","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT INHIB PROTEIN C,ANTIGEN - PROTEIN C ANTIGEN TOTAL","code_information":[{"code":"3058530201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85302","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.45,"discounted_cash":81.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT INHIB PROTEIN C,ACTIV - PROTEIN C ACTIVITY","code_information":[{"code":"3058530301","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85303","type":"HCPCS"}],"standard_charges":[{"gross_charge":65.14,"discounted_cash":65.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT INHIB PROTEIN S,TOTAL - PROTEIN S ANTIGEN TOTAL","code_information":[{"code":"3058530502","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85305","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.6,"discounted_cash":33.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ACTIVITY","code_information":[{"code":"3058530601","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.34,"discounted_cash":44.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOT INHIB PROTEIN S,FREE - PROTEIN S ANTIGEN FREE","code_information":[{"code":"3058530602","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85306","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.75,"discounted_cash":35.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACTIVATED PROT C (APC) RESISTNCE ASSAY - APC RESISTANCE","code_information":[{"code":"3058530701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85307","type":"HCPCS"}],"standard_charges":[{"gross_charge":57.03,"discounted_cash":57.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COAGULATION TIME, ACTIVATED - ACTIVATED CLOTTING TIME","code_information":[{"code":"3058534701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.96,"discounted_cash":192.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC KAOLIN CLOT TIME WITH REFLEX","code_information":[{"code":"3058534705","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.96,"discounted_cash":192.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC KAOLIN CLOT TIME - LUPUS ANTICOAGULANT SCREEN","code_information":[{"code":"3058534706","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85347","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.96,"discounted_cash":192.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FIBRIN DEGRAD PRODUCTS, AGGLUTINATION - FIBRIN SPLIT PRODUCTS","code_information":[{"code":"3058536201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85362","type":"HCPCS"}],"standard_charges":[{"gross_charge":269.82,"discounted_cash":269.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC D-DIMER QUANTITATIVE","code_information":[{"code":"3058537901","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85379","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.46,"discounted_cash":333.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FIBRINOGEN QUANTITATIVE","code_information":[{"code":"3058538401","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85384","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.24,"discounted_cash":240.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FIBRINOGEN, ANTIGEN - FIBRINOGEN ANTIGEN","code_information":[{"code":"3058538501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85385","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.46,"discounted_cash":61.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPECIAL COAGULATION INTERPRETATION AND REPORT","code_information":[{"code":"3058539001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85390","type":"HCPCS"}],"standard_charges":[{"gross_charge":178.06,"discounted_cash":178.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ADAMTS13 ACTIVITY","code_information":[{"code":"3058539701","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85397","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.29,"discounted_cash":172.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLASMINOGEN ACTIVATOR INHIBITOR","code_information":[{"code":"3058541501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85415","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.9,"discounted_cash":162.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FIBRINOLYTIC PLASMINOGEN - PLASMINOGEN ACTIVITY","code_information":[{"code":"3058542001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85420","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.84,"discounted_cash":42.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPARIN ANTI XA ASSAY, UNFRACTIONATED","code_information":[{"code":"3058552002","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.59,"discounted_cash":190.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPARIN ANTI-XA QUALITATIVE REFLEXED - ARUP","code_information":[{"code":"3058552006","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85520","type":"HCPCS"}],"standard_charges":[{"gross_charge":190.59,"discounted_cash":190.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPARIN NEUTRALIZATION","code_information":[{"code":"3058552501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85525","type":"HCPCS"}],"standard_charges":[{"gross_charge":127.07,"discounted_cash":127.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WBC ALKALINE PHOSPHATASE - LEUKOCYTE ALKALINE PHOSPHATASE","code_information":[{"code":"3058554001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85540","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MURAMIDASE - LYSOZYME, SERUM","code_information":[{"code":"3058554901","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.35,"discounted_cash":69.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LYSOZYME SERUM - ARUP","code_information":[{"code":"3058554903","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85549","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.35,"discounted_cash":69.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PLATELET AGGREGATION - P2Y12 PROFILE","code_information":[{"code":"3058557602","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.42,"discounted_cash":351.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COLLAGEN - PLATELET AGGREGATION","code_information":[{"code":"3058557609","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.11,"discounted_cash":192.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELET FUNCTION ASPIRIN","code_information":[{"code":"3058557612","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.24,"discounted_cash":240.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELET FUNCTION ASPIRIN","code_information":[{"code":"3058557619","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.24,"discounted_cash":240.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ADP/PGE1 - P2Y12 PLATELET FUNCTION","code_information":[{"code":"3058557623","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.42,"discounted_cash":351.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ISO-TRAP - P2Y12 PLATELET FUNCTION","code_information":[{"code":"3058557624","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85576","type":"HCPCS"}],"standard_charges":[{"gross_charge":351.42,"discounted_cash":351.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHOSPHOLIPID NEUTRALIZATION - HEXAGONAL PHOSPHOLIPID","code_information":[{"code":"3058559801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.58,"discounted_cash":89.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEXAGONAL PHOSPHOLIPID NEUTRAL (STACLOT LUPUS ANTICOAGULANT)","code_information":[{"code":"3058559802","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.58,"discounted_cash":89.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEXAGONAL PHOSPHOLIPID NEUTRAL REFLEX - ARUP","code_information":[{"code":"3058559804","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85598","type":"HCPCS"}],"standard_charges":[{"gross_charge":89.58,"discounted_cash":89.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTHROMBIN TIME INR","code_information":[{"code":"3058561001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTHROMBIN TIME INR COUMADIN CLINIC","code_information":[{"code":"3058561003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTHROMBIN TIME INR - LUPUS ANTICOAGULANT PANEL WITH REFLEX -ARUP","code_information":[{"code":"3058561010","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.96,"discounted_cash":28.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTHROMBIN TIME SPECIAL COAGULATION - INHIBITOR SCREEN","code_information":[{"code":"3058561012","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTHROMBIN TIME - PT AND PTT PANEL","code_information":[{"code":"3058561013","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTHROMBIN TIME -ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3058561014","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85610","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.03,"discounted_cash":121.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTHROMBIN TEST,SUBSTI,FRACTN - EQUAL MIX,PT/INR","code_information":[{"code":"3058561101","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROTHROMBIN TIME MIXING STUDY","code_information":[{"code":"3058561104","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85611","type":"HCPCS"}],"standard_charges":[{"gross_charge":11.4,"discounted_cash":11.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME)","code_information":[{"code":"3058561301","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - DRVVT (DILUTE RUSSEL VV TIME) - PHOSLIPID ARUP","code_information":[{"code":"3058561302","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RUSSELL VIPER VENOM, DILUTED - LUPUS ANTICOAGULANT PANEL W/REFLEX -ARUP","code_information":[{"code":"3058561303","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DILUTED RUSSEL VIPER VENOM (DRVVT) - LUPUS ANTICOAGULANT SCREEN","code_information":[{"code":"3058561307","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DILUTED RUSSELL VIPER VENOM (DRVTT)","code_information":[{"code":"3058561308","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRVVT - ANTIPHOSPHOLIPID SYNDROME REFLX PANEL - ARUP","code_information":[{"code":"3058561310","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85613","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.88,"discounted_cash":22.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REPTILASE TIME","code_information":[{"code":"3058563501","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85635","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.74,"discounted_cash":40.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RBC SED RATE, AUTO - SEDIMENTATION RATE, AUTOMATED","code_information":[{"code":"3058565201","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85652","type":"HCPCS"}],"standard_charges":[{"gross_charge":189.19,"discounted_cash":189.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RBC SICKLE CELL TEST - SICKLE CELL SCREEN","code_information":[{"code":"3058566001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SICKLE CELL SOLUBILITY BILL - ARUP","code_information":[{"code":"3058566003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85660","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.29,"discounted_cash":23.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THROMBIN TIME, PLASMA - THROMBIN TIME","code_information":[{"code":"3058567001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85670","type":"HCPCS"}],"standard_charges":[{"gross_charge":8.94,"discounted_cash":8.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APTT","code_information":[{"code":"3058573001","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.76,"discounted_cash":160.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APTT LUPUS SENSITIVE","code_information":[{"code":"3058573003","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.47,"discounted_cash":156.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APTT - LUPUS ANTICOAGULANT PANEL WITH REFLEX - ARUP","code_information":[{"code":"3058573011","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":91.88,"discounted_cash":91.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APTT - LUPUS ANTICOAGULANT SCREEN","code_information":[{"code":"3058573015","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.76,"discounted_cash":160.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) LUPUS SENS-INHIBITOR SCREEN","code_information":[{"code":"3058573016","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.76,"discounted_cash":160.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACTIVATED PARTIAL THROMBOPLASTIN TIME (APTT) - PT AND PTT PANEL","code_information":[{"code":"3058573017","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.76,"discounted_cash":160.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APTT - ANTIPHOSPHOLIPID SYNDROME REFLEX PANEL - ARUP","code_information":[{"code":"3058573018","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85730","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.96,"discounted_cash":28.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LUPUS ANTICOAGULANT PTT 1 TO 1 MIX","code_information":[{"code":"3058573203","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":35.46,"discounted_cash":35.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APTT 1:1 MIX INHIBITOR SCREEN ASSAY (REFLX) (ARUP)","code_information":[{"code":"3058573206","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.36,"discounted_cash":56.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APTT 1:1 MIX INHIBITOR SCREEN 1-HOUR  (REFLX) (ARUP)","code_information":[{"code":"3058573207","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.36,"discounted_cash":56.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INHIBITOR SCREEN CHARGE","code_information":[{"code":"3058573208","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.36,"discounted_cash":56.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PTT 1:1 MIX LUPUS SENSITIVE REFLEX","code_information":[{"code":"3058573211","type":"CDM"},{"code":"0305","type":"RC"},{"code":"85732","type":"HCPCS"}],"standard_charges":[{"gross_charge":56.36,"discounted_cash":56.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHYSICIAN TRANSFUSION REACTION INTERP & REPORT","code_information":[{"code":"3058607801","type":"CDM"},{"code":"0305","type":"RC"},{"code":"86078","type":"HCPCS"}],"standard_charges":[{"gross_charge":272.23,"discounted_cash":272.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIAL VAGINOSIS TMA - SURESWAB VAGINOSIS/VAGINITIS PLUS 10120 - QDID","code_information":[{"code":"3068151303","type":"CDM"},{"code":"0306","type":"RC"},{"code":"81513","type":"HCPCS"}],"standard_charges":[{"gross_charge":446.18,"discounted_cash":446.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CONCENTRATION - PNEUMOCYSTIS SMEAR BY DFA - ARUP","code_information":[{"code":"3068701501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.32,"discounted_cash":36.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INFECTIOUS AGENT CONCENTRATION FECES","code_information":[{"code":"3068701502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":81.53,"discounted_cash":81.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPECIMEN CONCENTRATION AFB CULTURE","code_information":[{"code":"3068701512","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.32,"discounted_cash":36.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMOCYSTIS JIROVECII CONC - P JIROVECII DFA - ARUP","code_information":[{"code":"3068701514","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.32,"discounted_cash":36.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPECIMEN CONCENTRATION - SPINAL FLUID CULTURE","code_information":[{"code":"3068701515","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87015","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.32,"discounted_cash":36.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CULTURE BLOOD","code_information":[{"code":"3068704001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87040","type":"HCPCS"}],"standard_charges":[{"gross_charge":250.61,"discounted_cash":250.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE STOOL - SALMONELLA SHIGELLA","code_information":[{"code":"3068704501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SALMONELLA SHIGELLA - STOOL CULTURE - ARUP","code_information":[{"code":"3068704502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87045","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.03,"discounted_cash":19.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STOOL CULTURE, ADDL PATHOGENS - YERSINIA CULTURE, STOOL","code_information":[{"code":"3068704602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.18,"discounted_cash":242.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STOOL CULTURE, ADDL PATHOGENS - ADDITIONAL PATHOGEN CULTURE, STOOL","code_information":[{"code":"3068704603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.18,"discounted_cash":242.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VIBRIO STOOL CULTURE REFLEXED","code_information":[{"code":"3068704604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.18,"discounted_cash":242.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CAMPYLOBACTER - STOOL CULTURE - ARUP","code_information":[{"code":"3068704605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.18,"discounted_cash":242.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC YERSINIA STOOL CULTURE - ARUP","code_information":[{"code":"3068704606","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.18,"discounted_cash":242.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC E COLI - STOOL CULTURE - ARUP","code_information":[{"code":"3068704607","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.18,"discounted_cash":242.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC YERSINIA STOOL CULTURE REFLEX","code_information":[{"code":"3068704608","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87046","type":"HCPCS"}],"standard_charges":[{"gross_charge":242.18,"discounted_cash":242.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE AEROBIC","code_information":[{"code":"3068707001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL CULTURE","code_information":[{"code":"3068707004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THROAT CULTURE COMPREHENSIVE","code_information":[{"code":"3068707007","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRONCHIAL LAVAGE CULTURE","code_information":[{"code":"3068707011","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH TIP CULTURE","code_information":[{"code":"3068707012","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CSF CULTURE WITH GRAM STAIN","code_information":[{"code":"3068707013","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENVIRONMENTAL CULTURE","code_information":[{"code":"3068707015","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENITAL CULTURE","code_information":[{"code":"3068707019","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPUTUM CULTURE","code_information":[{"code":"3068707022","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87070","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.46,"discounted_cash":413.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE AEROBIC QUANT","code_information":[{"code":"3068707101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87071","type":"HCPCS"}],"standard_charges":[{"gross_charge":252.08,"discounted_cash":252.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE ANAEROBIC","code_information":[{"code":"3068707501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSTRIDIUM DIFFICILE CULTURE - ARUP","code_information":[{"code":"3068707503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.08,"discounted_cash":19.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANEROBIC CULTURE - ARUP","code_information":[{"code":"3068707504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87075","type":"HCPCS"}],"standard_charges":[{"gross_charge":32.0,"discounted_cash":32.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE ANAEROBIC ADDITIONAL ID METHOD","code_information":[{"code":"3068707601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANAEROBIC CULTURE IDENTIFICATION - ARUP","code_information":[{"code":"3068707602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87076","type":"HCPCS"}],"standard_charges":[{"gross_charge":16.3,"discounted_cash":16.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIA IDENTIFICATION AEROBIC","code_information":[{"code":"3068707702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87077","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.25,"discounted_cash":147.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIA CULTURE SCREEN - LEGIONELLA CULTURE","code_information":[{"code":"3068708101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NOCARDIA CULTURE","code_information":[{"code":"3068708102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE PATHOGEN CULTURE","code_information":[{"code":"3068708104","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE MRSA CULTURE","code_information":[{"code":"3068708105","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE GC CULTURE","code_information":[{"code":"3068708108","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE GROUP B STREP CULTURE","code_information":[{"code":"3068708109","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BACTERIA CULTURE SCREEN - PRESUMPTIVE GROUP A STREP CULTURE","code_information":[{"code":"3068708110","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VIBRIO CULTURE STOOL - ARUP","code_information":[{"code":"3068708117","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STREP THROAT A CULTURE","code_information":[{"code":"3068708122","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87081","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.29,"discounted_cash":310.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CULTURE URINE QUANTITATIVE","code_information":[{"code":"3068708601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87086","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.27,"discounted_cash":263.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CULTURE FUNGI-SKIN HAIR NAILS - FUNGAL CULTURE, CUTANEOUS","code_information":[{"code":"3068710101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87101","type":"HCPCS"}],"standard_charges":[{"gross_charge":15.55,"discounted_cash":15.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE FUNGUS","code_information":[{"code":"3068710201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87102","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.0,"discounted_cash":29.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FUNGUS BLOOD CULTURE","code_information":[{"code":"3068710301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87103","type":"HCPCS"}],"standard_charges":[{"gross_charge":163.07,"discounted_cash":163.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - YEAST ID","code_information":[{"code":"3068710601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87106","type":"HCPCS"}],"standard_charges":[{"gross_charge":318.57,"discounted_cash":318.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FUNGUS IDENTIFICATION, MOLD - FUNGAL IDENTIFICATION, MOLD","code_information":[{"code":"3068710701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87107","type":"HCPCS"}],"standard_charges":[{"gross_charge":22.18,"discounted_cash":22.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE CHLAMYDIA","code_information":[{"code":"3068711001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87110","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.09,"discounted_cash":59.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AFB CULTURE","code_information":[{"code":"3068711601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.83,"discounted_cash":201.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD CULTURE ACID FAST BACTERIA","code_information":[{"code":"3068711602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.83,"discounted_cash":201.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AFB CULTURE - ARUP","code_information":[{"code":"3068711605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87116","type":"HCPCS"}],"standard_charges":[{"gross_charge":80.0,"discounted_cash":80.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYCOBACTERIA IDENTIFICATION - MYCOBACTERIA IDENTIFICATION","code_information":[{"code":"3068711801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87118","type":"HCPCS"}],"standard_charges":[{"gross_charge":21.78,"discounted_cash":21.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CULTURE TYPING, FLUORESCENT - TYPING EACH","code_information":[{"code":"3068714002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87140","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.54,"discounted_cash":66.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - SEROTYPING","code_information":[{"code":"3068714701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.0,"discounted_cash":92.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - SEROTYPING MRSA PBP2","code_information":[{"code":"3068714702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87147","type":"HCPCS"}],"standard_charges":[{"gross_charge":88.65,"discounted_cash":88.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PATHOGEN GRAM NEG ID RESISTANCE PCR 6 + TARGETS","code_information":[{"code":"3068715401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.08,"discounted_cash":631.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PATHOGEN GRAM POS ID RESISTANCE PCR 6 + TARGETS","code_information":[{"code":"3068715402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.08,"discounted_cash":631.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PATHOGEN FUNGAL ID RESISTANCE PCR 6 + TARGETS","code_information":[{"code":"3068715403","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87154","type":"HCPCS"}],"standard_charges":[{"gross_charge":631.08,"discounted_cash":631.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE TYPING OTHER","code_information":[{"code":"3068715801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87158","type":"HCPCS"}],"standard_charges":[{"gross_charge":25.6,"discounted_cash":25.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARTHROPOD AND PARASITE IDENTIFICATION MACROSCOPIC","code_information":[{"code":"3068716901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87169","type":"HCPCS"}],"standard_charges":[{"gross_charge":47.26,"discounted_cash":47.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE HOMOGENIZATION FOR CULTURE","code_information":[{"code":"3068717601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87176","type":"HCPCS"}],"standard_charges":[{"gross_charge":61.86,"discounted_cash":61.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OVA AND PARASITES SMEARS - OVA AND PARASITE EXAMINATION","code_information":[{"code":"3068717701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":30.0,"discounted_cash":30.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OVA & PARASITE DIR SMEARS, CONC, ID - O&P EXAM BODY FLUID/URINE - ARUP","code_information":[{"code":"3068717705","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87177","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.94,"discounted_cash":17.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUSCEPTIBILITY E-TEST PER AGENT","code_information":[{"code":"3068718101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.5,"discounted_cash":196.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MIC SENSITIVITY (E-TEST)","code_information":[{"code":"3068718102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87181","type":"HCPCS"}],"standard_charges":[{"gross_charge":14.78,"discounted_cash":14.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUSCEPTIBILITY KIRBY BAUER SINGLE ANTIBIOTIC","code_information":[{"code":"3068718401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87184","type":"HCPCS"}],"standard_charges":[{"gross_charge":28.08,"discounted_cash":28.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE SUSCEPTIBILITY ENZYME","code_information":[{"code":"3068718501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87185","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.64,"discounted_cash":19.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUSCEPTIBILITY MIC GRAM NEGATIVE","code_information":[{"code":"3068718601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.58,"discounted_cash":188.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION YEAST","code_information":[{"code":"3068718605","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.58,"discounted_cash":188.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUSCEPTIBILITY MIC MICRODILUTION GRAM POSITIVE","code_information":[{"code":"3068718606","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.58,"discounted_cash":188.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUSCEPTIBILITY MIC GRAM POSITIVE","code_information":[{"code":"3068718607","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.03,"discounted_cash":601.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUSCEPTIBILITY MIC STREPTOCOCCUS","code_information":[{"code":"3068718610","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.03,"discounted_cash":601.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUSCEPTIBILITY MIC YEAST","code_information":[{"code":"3068718611","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87186","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.58,"discounted_cash":188.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EOSINOPHILS SMEAR URINE","code_information":[{"code":"3068720502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GRAM STAIN","code_information":[{"code":"3068720503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.06,"discounted_cash":311.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DFT - DIFFERENTIAL BRONCHIAL LAVAGE/WASH","code_information":[{"code":"3068720505","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.95,"discounted_cash":119.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRONCHIAL WASH DIFFERENTIAL","code_information":[{"code":"3068720506","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.95,"discounted_cash":119.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EOSINOPHILS SMEAR URINE - EOSINOPHILS COUNT % URINE","code_information":[{"code":"3068720507","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87205","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.35,"discounted_cash":141.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMEAR,FLUOR STAIN,INTERP - AFB STAIN","code_information":[{"code":"3068720601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":18.0,"discounted_cash":18.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FUNGAL STAIN, FLUORESCENT","code_information":[{"code":"3068720602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87206","type":"HCPCS"}],"standard_charges":[{"gross_charge":4.86,"discounted_cash":4.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SMEAR,INCLUSION BODIES/PARASITES,INTERP - MALARIA SMEAR","code_information":[{"code":"3068720701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.56,"discounted_cash":38.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MALARIA RAPID SCREEN WITH GIEMSA - ARUP","code_information":[{"code":"3068720709","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87207","type":"HCPCS"}],"standard_charges":[{"gross_charge":38.56,"discounted_cash":38.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WET PREP GENITAL","code_information":[{"code":"3068721001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87210","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.05,"discounted_cash":244.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE EXAM BY KOH - KOH PREP","code_information":[{"code":"3068722001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.17,"discounted_cash":27.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FUNGAL (KOH) STAIN","code_information":[{"code":"3068722002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87220","type":"HCPCS"}],"standard_charges":[{"gross_charge":27.17,"discounted_cash":27.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASSAY, TOXIN OR ANTITOXIN - CLOSTRIDIUM DIFFICILE TOXINS TISSUE CULT","code_information":[{"code":"3068723001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87230","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.15,"discounted_cash":212.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - CULTURE VIRUS TISSUE","code_information":[{"code":"3068725201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.95,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VIRAL CULTURE RESPIRATORY - ARUP","code_information":[{"code":"3068725204","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87252","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.95,"discounted_cash":33.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX VIRUS (HSV) CULTURE - ARUP","code_information":[{"code":"3068725304","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87253","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.08,"discounted_cash":93.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX VIRUS CULTURE - ARUP","code_information":[{"code":"3068725502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87255","type":"HCPCS"}],"standard_charges":[{"gross_charge":93.32,"discounted_cash":93.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ADENOVIRUS DFA - RESPIRATORY VIRUSES DFA WITH REFLEX - ARUP","code_information":[{"code":"3068726004","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87260","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.08,"discounted_cash":36.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INFLUENZA B AG, DFA","code_information":[{"code":"3068727501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87275","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.52,"discounted_cash":40.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INFLUENZA A AG, DFA","code_information":[{"code":"3068727601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87276","type":"HCPCS"}],"standard_charges":[{"gross_charge":55.7,"discounted_cash":55.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARAINFLUENZA AG BY DFA","code_information":[{"code":"3068727901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87279","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.34,"discounted_cash":54.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESP SYNCYTIAL AG, DFA","code_information":[{"code":"3068728001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87280","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.38,"discounted_cash":44.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMOCYSTIS JIROVECII AG, DFA -  (ARUP)","code_information":[{"code":"3068728102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87281","type":"HCPCS"}],"standard_charges":[{"gross_charge":39.63,"discounted_cash":39.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AG DETECTION IMMUNOFLOUR EA ORG","code_information":[{"code":"3068729902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87299","type":"HCPCS"}],"standard_charges":[{"gross_charge":44.37,"discounted_cash":44.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IAAD IA QUAL/SEMIQUAN MULTIPLE STEP ASPERGILLUS - ASPERGILLUS GALACT","code_information":[{"code":"3068730501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.53,"discounted_cash":84.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASPERGILLUS GALACTOMANNAN ANTIGEN","code_information":[{"code":"3068730502","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87305","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.53,"discounted_cash":84.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TOXINS EIA","code_information":[{"code":"3068732401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.18,"discounted_cash":149.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TOXINS EIA","code_information":[{"code":"3068732402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87324","type":"HCPCS"}],"standard_charges":[{"gross_charge":149.18,"discounted_cash":149.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CRYPTOSPORIDIUM - OVA AND PARASITE ANTIGEN SCREEN","code_information":[{"code":"3068732801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.75,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CRYPTOSPORIDIUM ANTIGEN STOOL - ARUP","code_information":[{"code":"3068732802","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87328","type":"HCPCS"}],"standard_charges":[{"gross_charge":135.75,"discounted_cash":135.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GIARDIA LAMBLIA - OVA AND PARASITE ANTIGEN SCREEN","code_information":[{"code":"3068732901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.55,"discounted_cash":143.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GIARDIA ANTIGEN STOOL - ARUP","code_information":[{"code":"3068732902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87329","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.55,"discounted_cash":143.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HELICOBACTER PYLORI ANTIGEN STOOL","code_information":[{"code":"3068733801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87338","type":"HCPCS"}],"standard_charges":[{"gross_charge":59.09,"discounted_cash":59.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN","code_information":[{"code":"3068734001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87340","type":"HCPCS"}],"standard_charges":[{"gross_charge":85.68,"discounted_cash":85.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IAAD IA HEPATITIS B SURFACE AG NEUTRALIZATION - HEPATITIS B SURFACE","code_information":[{"code":"3068734101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.9,"discounted_cash":29.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B SURFACE ANTIGEN CONFIRMATION - ARUP","code_information":[{"code":"3068734102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87341","type":"HCPCS"}],"standard_charges":[{"gross_charge":29.9,"discounted_cash":29.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IAAD IA HEPATITIS BE ANTIGEN - HEPATITIS B E ANTIGEN","code_information":[{"code":"3068735001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEAPATITIS B E ANTIGEN - ARUP","code_information":[{"code":"3068735002","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87350","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.72,"discounted_cash":17.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IAAD IA HISTOPLASM CAPSULATUM - HISTOPLASMA ANTIGEN URINE","code_information":[{"code":"3068738501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.53,"discounted_cash":162.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HISTOPLASM ANTIGEN URINE - ARUP","code_information":[{"code":"3068738503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.53,"discounted_cash":162.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HISTOPLASMA ANTIGEN SERUM - ARUP","code_information":[{"code":"3068738504","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87385","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.53,"discounted_cash":162.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IAAD IA ROTAVIRUS - ROTAVIRUS ANTIGEN STOOL","code_information":[{"code":"3068742501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.17,"discounted_cash":24.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ROTAVIRUS ANTIGEN EIA STOOL - ARUP","code_information":[{"code":"3068742503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87425","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.17,"discounted_cash":24.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IAAD IA SHIGA-LIKE TOXIN - SHIGA-LIKE TOXIN ANTIGEN,  FECES","code_information":[{"code":"3068742702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":33.02,"discounted_cash":33.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SHIGA-LIKE TOXIN ANTIGEN EIA STOOL - ARUP","code_information":[{"code":"3068742704","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87427","type":"HCPCS"}],"standard_charges":[{"gross_charge":23.02,"discounted_cash":23.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LEGIONELLA ANTIGEN URINE","code_information":[{"code":"3068744901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.5,"discounted_cash":264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSTRIDIUM DIFFICILE AG TOXINS EIA","code_information":[{"code":"3068744903","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.5,"discounted_cash":264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CAMPYLOBACTER AG TOXINS EIA - ARUP","code_information":[{"code":"3068744904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.5,"discounted_cash":264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 1,3 BETA D-GLUCAN (FUNGITELL)","code_information":[{"code":"3068744905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.5,"discounted_cash":264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CAMPYLOBACTER ANTIGEN STOOL - ARUP","code_information":[{"code":"3068744910","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87449","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.5,"discounted_cash":264.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM AMP PROBE","code_information":[{"code":"3068746801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.34,"discounted_cash":123.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANAPLASMA PHAGOCYTOPHILUM PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068746803","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87468","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.34,"discounted_cash":123.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BABESIA MICROTI AMP PROBE","code_information":[{"code":"3068746901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":96.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BABESIA MICROTI PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068746902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87469","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":96.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA, DNA, AMP PROBE - BARTONELLA, DNA, AMP PROBE","code_information":[{"code":"3068747101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87471","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.49,"discounted_cash":230.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BARTONELLA DNA QUALITATIVE PCR - ARUP","code_information":[{"code":"3068747103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87471","type":"HCPCS"}],"standard_charges":[{"gross_charge":230.49,"discounted_cash":230.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LYME DIS, DNA, AMP PROBE - LYME DISEASE (BORRELIA BURGDORFERI), PCR","code_information":[{"code":"3068747601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.06,"discounted_cash":116.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LYME DISEASE (BORRELIA BURGDORFERI) PCR - ARUP","code_information":[{"code":"3068747603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87476","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.06,"discounted_cash":116.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CANDIDA, DNA, AMP PROBE - CANDIDA DNA, PCR","code_information":[{"code":"3068748101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.16,"discounted_cash":862.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CANDIDA GLABRATA - SURESWAB VAGINOSIS/VAGINITIS PLUS 10120 - QDID","code_information":[{"code":"3068748109","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.89,"discounted_cash":54.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CANDIDA SPECIES - SURESWAB VAGINOSIS/VAGINITIS PLUS 10120 - QDID","code_information":[{"code":"3068748114","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":54.89,"discounted_cash":54.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C ALBICANS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748119","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.16,"discounted_cash":862.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C GLABRATA - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748120","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.16,"discounted_cash":862.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C PARAPSILOSIS COMPLEX - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748121","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.16,"discounted_cash":862.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C TROPICALIS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748122","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.16,"discounted_cash":862.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C KRUSEI - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748123","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.16,"discounted_cash":862.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C DUBLINIENSIS - CANDIDA SPECIES BY PCR - ARUP","code_information":[{"code":"3068748124","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87481","type":"HCPCS"}],"standard_charges":[{"gross_charge":862.16,"discounted_cash":862.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - DNA AMP PROBE 12-25 TARGETS","code_information":[{"code":"3068748301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87483","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.17,"discounted_cash":766.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EHRLICHIA CHAFEENSIS AMP PROBE","code_information":[{"code":"3068748401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.34,"discounted_cash":123.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EHRLICHIA CHAFFEENSIS PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068748403","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87484","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.34,"discounted_cash":123.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHLAMYDIA TRACHOMATIS DNA PROBE AMPLIFIED","code_information":[{"code":"3068749101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.37,"discounted_cash":226.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C TRACHOMATIS TMA - SURESWAB VAGINOSIS/VAGINITIS PLUS 10120 - QDID","code_information":[{"code":"3068749111","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.78,"discounted_cash":109.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C TRACHOMATIS - C TRACHOMATIS, N GONORRHOEAE, RNA TMA UROGENITAL - QDID","code_information":[{"code":"3068749112","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.37,"discounted_cash":226.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC C TRACHOMATIS - C TRACHOMATIS, N GONORRHOEAE, RNA TMA RECTAL - QDID","code_information":[{"code":"3068749113","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87491","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.37,"discounted_cash":226.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSTRIDIOIDES DIFFICILE TOXIN TCBD GENE PCR","code_information":[{"code":"3068749301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87493","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.22,"discounted_cash":319.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYTOMEG, DNA, AMP PROBE - CYTOMEGALOVIRUS DNA PROBE, AMPLIFIED","code_information":[{"code":"3068749601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.57,"discounted_cash":101.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) PCR URINE","code_information":[{"code":"3068749602","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":96.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYTOMEGALOVIRUS (CMV) PCR QUAL - ARUP","code_information":[{"code":"3068749604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87496","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.57,"discounted_cash":101.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CMV QUANT PCR","code_information":[{"code":"3068749701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87497","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.38,"discounted_cash":301.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENTEROVIRUS PROBE&REVRS TRNS - ENTEROVIRUS DNA PROBE, AMPLIFIED","code_information":[{"code":"3068749801","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.53,"discounted_cash":162.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENTEROVIRUS PCR QUAL","code_information":[{"code":"3068749805","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87498","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.53,"discounted_cash":162.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INFLUENZA A & B PCR","code_information":[{"code":"3068750201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87502","type":"HCPCS"}],"standard_charges":[{"gross_charge":454.5,"discounted_cash":454.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GASTROINTESTINAL PARASITE PANELY BY PCR 5 TARGETS - ARUP","code_information":[{"code":"3068750501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":319.08,"discounted_cash":319.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GASTROINTESTINAL VIRAL PCR PANEL STOOL - 5 TARGETS","code_information":[{"code":"3068750503","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87505","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.61,"discounted_cash":353.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GASTROINTESTINAL BACTERIAL PCR PANEL STOOL - 6 -11 TARGETS","code_information":[{"code":"3068750601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87506","type":"HCPCS"}],"standard_charges":[{"gross_charge":691.13,"discounted_cash":691.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IADNA-DNA/RNA PROBE TQ 12-25 - GASTROINTESTINAL PANEL","code_information":[{"code":"3068750701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1915.4,"discounted_cash":1915.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GASTROINTESTINAL PATHOGENS PANEL PCR STOOL - 21 TARGETS","code_information":[{"code":"3068750702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87507","type":"HCPCS"}],"standard_charges":[{"gross_charge":1915.4,"discounted_cash":1915.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA, ULTRAQUANTITATIVE, PCR","code_information":[{"code":"3068751701","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.1,"discounted_cash":124.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B , DNA, QUANT - HEPATITIS B DNA PROBE, DIRECT","code_information":[{"code":"3068751702","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":172.43,"discounted_cash":172.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS B PCR QUANTITATIVE - HEPATITIS B DNA QUATITATIVE PCR","code_information":[{"code":"3068751704","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87517","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.1,"discounted_cash":124.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IADNA HEPATITIS C QUANT & REVERSE TRANSCRIPTION - HCV QUANT PCR","code_information":[{"code":"3068752201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.8,"discounted_cash":537.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS C BY QUANT NAAT WITH REFLEX GENOTYPE - ARUP","code_information":[{"code":"3068752206","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87522","type":"HCPCS"}],"standard_charges":[{"gross_charge":537.8,"discounted_cash":537.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV QUAL PCR","code_information":[{"code":"3068752901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HERPES SIMPLEX VIRUS 1 & 2 PCR QUALITATIVE","code_information":[{"code":"3068752902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV 1 PCR - HSV PCR QUAL NONBLOOD","code_information":[{"code":"3068752904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV 2 PCR - HSV PCR QUAL NONBLOOD","code_information":[{"code":"3068752905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV 1 PCR QUAL - HSV 1 AND 2 SUBTYPE BY PCR - ARUP","code_information":[{"code":"3068752907","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV 2 PCR QUAL - HSV 1 AND 2 SUBTYPE BY PCR - ARUP","code_information":[{"code":"3068752908","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV-1 - T PALLIDUM, HSV-1, HSV-2 BY PCR - ARUP","code_information":[{"code":"3068752911","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HSV-2 - T PALLIDUM, HSV-1, HSV-2 BY PCR - ARUP","code_information":[{"code":"3068752912","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87529","type":"HCPCS"}],"standard_charges":[{"gross_charge":73.88,"discounted_cash":73.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV-1 PROBE&REVERSE TRNSCRPJ - HIV-1 DNA PROBE, AMPLIFIED","code_information":[{"code":"3068753501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.49,"discounted_cash":394.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV 1 RNA PCR QUAL TMA - QDID","code_information":[{"code":"3068753505","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87535","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.49,"discounted_cash":394.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV 1 RNA QUANT PCR - QDID","code_information":[{"code":"3068753601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.06,"discounted_cash":1032.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV 1 PCR QUANTITATIVE","code_information":[{"code":"3068753604","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87536","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC M TUBERCULOSIS COMPLEX, DNA PCR AMPLIFIED","code_information":[{"code":"3068755601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":268.5,"discounted_cash":268.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYCOBACTERIUM TUBERCULOSIS DNA PROBE DIRECT","code_information":[{"code":"3068755603","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87556","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYCOPLASMA PNEUMONIAE PCR - ARUP","code_information":[{"code":"3068758103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87581","type":"HCPCS"}],"standard_charges":[{"gross_charge":192.96,"discounted_cash":192.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEISSERIA GONORRHOEA DNA PROBE","code_information":[{"code":"3068759101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.96,"discounted_cash":225.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N GONORRHOEAE TMA - SURESWAB VAGINOSIS/VAGINITIS PLUS 10120 - QDID","code_information":[{"code":"3068759112","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.78,"discounted_cash":109.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N GONORRHOEAE - C TRACHOMATIS, N GONORRHOEAE, RNA TMA RECTAL - QDID","code_information":[{"code":"3068759114","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.96,"discounted_cash":225.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC N GONORRHOEAE - C TRACHOMATIS, N GONORRHOEAE, RNA TMA THROAT - QDID","code_information":[{"code":"3068759115","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87591","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.96,"discounted_cash":225.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMOCYSTIS JIROVECCI DNA PCR AMPLIFIED","code_information":[{"code":"3068759401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87594","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.0,"discounted_cash":300.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMOCYSTIS JIROVECII DNA PCR AMPLIFIED - ARUP","code_information":[{"code":"3068759402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87594","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IADNA HUMAN PAPILLOMAVIRUS HIGH-RISK TYPES - HPV DNA PROBE, DIRECT","code_information":[{"code":"3068762403","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87624","type":"HCPCS"}],"standard_charges":[{"gross_charge":160.25,"discounted_cash":160.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - AMP PROBE RESP 3-5 TARGETS","code_information":[{"code":"3068763101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.28,"discounted_cash":450.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESPIRATORY VIRUS MINI PANEL PCR - 3 TARGETS - ARUP","code_information":[{"code":"3068763102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87631","type":"HCPCS"}],"standard_charges":[{"gross_charge":450.28,"discounted_cash":450.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESPIRATORY VIRAL PANEL PCR - ARUP","code_information":[{"code":"3068763202","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87632","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.2,"discounted_cash":295.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IADNA RESPIRATRY PROBE & REV TRNSCR 12-25 TARGET - ADDITIONAL CHARGE","code_information":[{"code":"3068763301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.17,"discounted_cash":766.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESPIRATORY PANEL - 14 TARGETS","code_information":[{"code":"3068763303","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87633","type":"HCPCS"}],"standard_charges":[{"gross_charge":766.17,"discounted_cash":766.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COVID-19 SARS-COV-2 AMPLIFIED PROBE","code_information":[{"code":"3068763501","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87635","type":"HCPCS"}],"standard_charges":[{"gross_charge":364.65,"discounted_cash":364.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COVID-19, FLU A, FLU B PCR","code_information":[{"code":"3068763601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87636","type":"HCPCS"}],"standard_charges":[{"gross_charge":473.58,"discounted_cash":473.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STAPH AUREUS PCR - MRSA AND STAPH AUREUS PCR SCREEN NARES","code_information":[{"code":"3068764001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87640","type":"HCPCS"}],"standard_charges":[{"gross_charge":212.34,"discounted_cash":212.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRSA PCR - MRSA AND STAPH AUREUS PCR SCREEN NARES","code_information":[{"code":"3068764101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.13,"discounted_cash":406.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRSA RAPID SCREEN PCR NARES","code_information":[{"code":"3068764103","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87641","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.13,"discounted_cash":406.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STREP A, DNA, AMP PROBE - STREP A DNA PROBE, AMPLIFICATION","code_information":[{"code":"3068765101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":101.57,"discounted_cash":101.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STREP A DNA PROBE AMPLIFICATION THROAT","code_information":[{"code":"3068765102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87651","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.73,"discounted_cash":96.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STREP B DNA PCR PROBE","code_information":[{"code":"3068765301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87653","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.34,"discounted_cash":171.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - AMP PROBE TRICHOMONAS","code_information":[{"code":"3068766101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.02,"discounted_cash":402.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRICHOMONAS VAGINALIS BY TMA","code_information":[{"code":"3068766102","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.57,"discounted_cash":140.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRICHOMONAS VAGINALIS PCR PROBE","code_information":[{"code":"3068766106","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.02,"discounted_cash":402.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRICHOMONAS VAG TMA - SURESWAB VAGINOSIS/VAGINITIS PLUS 10120 - QDID","code_information":[{"code":"3068766112","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.78,"discounted_cash":109.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRICHOMONAS VAGINALIS RNA TMA QUAL MALES - QDID","code_information":[{"code":"3068766114","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87661","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.02,"discounted_cash":402.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DETECT AGENT NOS, DNA, AMP","code_information":[{"code":"3068779804","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JC VIRUS PCR","code_information":[{"code":"3068779810","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.78,"discounted_cash":361.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC WEST NILE VIRUS PCR","code_information":[{"code":"3068779812","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.5,"discounted_cash":171.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VARICELLA ZOSTER VIRUS PCR.","code_information":[{"code":"3068779813","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.02,"discounted_cash":402.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EHRLICHIA PCR","code_information":[{"code":"3068779819","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.11,"discounted_cash":288.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NOROVIRUS PCR","code_information":[{"code":"3068779821","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.43,"discounted_cash":103.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MTB RIFAMPIN PCR - DIRECT M. TUBERCULOSIS RIFAMPIN","code_information":[{"code":"3068779832","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NOROVIRUS 1 QUAL - NOROVIRUS GROUPS 1 AND 2 BY PCR - ARUP","code_information":[{"code":"3068779835","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.43,"discounted_cash":103.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NOROVIRUS 2 QUAL - NOROVIRUS GROUPS 1 AND 2 BY PCR - ARUP","code_information":[{"code":"3068779836","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":103.43,"discounted_cash":103.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMOCYSTIS JIROVECII PCR","code_information":[{"code":"3068779841","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PNEUMOCYSTIS JIROVECII PCR - ARUP","code_information":[{"code":"3068779842","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN BARR VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779849","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.54,"discounted_cash":105.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JC VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779853","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":361.78,"discounted_cash":361.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PAROVIRUS B19 PCR QUAL - ARUP","code_information":[{"code":"3068779854","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.32,"discounted_cash":419.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BABESIA SPECIES PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779855","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":262.4,"discounted_cash":262.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EHRLICHIA EWINGII/CANIS PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779856","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.11,"discounted_cash":288.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EHRLICHIA MURIS LIKE PCR - TICK BORNE DISEASE PANEL PCR - ARUP","code_information":[{"code":"3068779857","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.11,"discounted_cash":288.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TROPHERYMA WHIPPLEI (WHIPPLE DISEASE) PCR QUAL - ARUP","code_information":[{"code":"3068779861","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.06,"discounted_cash":116.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VARICELLA ZOSTER VIRUS PCR QUAL - ARUP","code_information":[{"code":"3068779865","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":402.02,"discounted_cash":402.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MEASLES (RUBEOLA) QUALITATIVE PCR, NP/THROAT - QUEST","code_information":[{"code":"3068779879","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.73,"discounted_cash":87.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MEASLES - MEASLES VIRUS BY QUAL NAAT - ARUP","code_information":[{"code":"3068779880","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.73,"discounted_cash":87.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MEASLES VACCINE STRAIN - MEASLES VIRUS BY QUAL NAAT - ARUP","code_information":[{"code":"3068779881","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87798","type":"HCPCS"}],"standard_charges":[{"gross_charge":87.73,"discounted_cash":87.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BK VIRUS PCR QUANT BLOOD","code_information":[{"code":"3068779901","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.75,"discounted_cash":147.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN BARR VIRUS (EBV) PCR QUANTITATIVE/QUALITATIVE","code_information":[{"code":"3068779902","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.7,"discounted_cash":141.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BK VIRUS PCR QUANT PLASMA - ARUP","code_information":[{"code":"3068779904","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.75,"discounted_cash":147.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EPSTEIN BARR VIRUS (EBV) QUANT NAAT PLASMA - ARUP","code_information":[{"code":"3068779905","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.7,"discounted_cash":141.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BK VIRUS PCR QUANT URINE","code_information":[{"code":"3068779913","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87799","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.75,"discounted_cash":147.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RAPID HIV ANTIBODY/ANTIGEN SCREEN","code_information":[{"code":"3068780601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87806","type":"HCPCS"}],"standard_charges":[{"gross_charge":194.5,"discounted_cash":194.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - STREP PNEUMO","code_information":[{"code":"3068789908","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.6,"discounted_cash":254.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AGENT NOS ASSAY W/OPTIC - UNLISTED ORGANISM","code_information":[{"code":"3068789909","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.6,"discounted_cash":254.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STREPTOCOCCUS PNEUMONIAE ANTIGEN URINE","code_information":[{"code":"3068789910","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87899","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.6,"discounted_cash":254.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - SUSCEPTIBILITY PHENOTYPE HIV","code_information":[{"code":"3068790001","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87900","type":"HCPCS"}],"standard_charges":[{"gross_charge":431.13,"discounted_cash":431.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - GENOTYPE BY NA - HIV1","code_information":[{"code":"3068790101","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87901","type":"HCPCS"}],"standard_charges":[{"gross_charge":512.98,"discounted_cash":512.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS C GENOTYPE","code_information":[{"code":"3068790201","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.82,"discounted_cash":339.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HCV NS5A DRUG RESISTANCE GENOTYPE - ARUP","code_information":[{"code":"3068790205","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.52,"discounted_cash":851.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATITIS C GENOTYPE - ARUP","code_information":[{"code":"3068790206","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.82,"discounted_cash":339.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HCV NS3 DRUG RESISTANCE GENOTYPE - QDID","code_information":[{"code":"3068790207","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87902","type":"HCPCS"}],"standard_charges":[{"gross_charge":851.52,"discounted_cash":851.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - NA PHENOTYPE DRUG RESIST 1-10 HIV1","code_information":[{"code":"3068790301","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87903","type":"HCPCS"}],"standard_charges":[{"gross_charge":1050.02,"discounted_cash":1050.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - NA PHENOTYPE DRUG RESIST EA ADD HIV1","code_information":[{"code":"3068790401","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87904","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.67,"discounted_cash":63.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HIV-1 PHENOTYPE 12 DRUG SUSCEPT - HIV-1 PHENOSENSE - ARUP","code_information":[{"code":"3068790402","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87904","type":"HCPCS"}],"standard_charges":[{"gross_charge":63.67,"discounted_cash":63.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIOLOGY - NA GENOTYPE HIV1 OTHER REGION","code_information":[{"code":"3068790601","type":"CDM"},{"code":"0306","type":"RC"},{"code":"87906","type":"HCPCS"}],"standard_charges":[{"gross_charge":425.78,"discounted_cash":425.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URINALYSIS AUTO WITH MICROSCOPIC","code_information":[{"code":"3078100101","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81001","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.19,"discounted_cash":179.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URINALYSIS DIPSTICK","code_information":[{"code":"3078100301","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":164.39,"discounted_cash":164.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URINALYSIS, AUTO, W/O SCOPE - URINALYSIS CHEM ONLY - PH","code_information":[{"code":"3078100303","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81003","type":"HCPCS"}],"standard_charges":[{"gross_charge":147.82,"discounted_cash":147.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC URINE PREGNANCY TEST - PREGNANCY URINE","code_information":[{"code":"3078102501","type":"CDM"},{"code":"0307","type":"RC"},{"code":"81025","type":"HCPCS"}],"standard_charges":[{"gross_charge":216.73,"discounted_cash":216.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEURO CSF PRION PRTN QUAL","code_information":[{"code":"3100035U01","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.22,"discounted_cash":697.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEURO PRION PROTEIN - 14 3 3 PROTEIN CSF - ARUP","code_information":[{"code":"3100035U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.22,"discounted_cash":697.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ORGANISM NGS KARIUS","code_information":[{"code":"3100152U01","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0152U","type":"HCPCS"}],"standard_charges":[{"gross_charge":5860.34,"discounted_cash":5860.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROBIAL CELL-FREE DNA BY SEQUENCING (KARIUS TEST)- ARUP","code_information":[{"code":"3100152U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0152U","type":"HCPCS"}],"standard_charges":[{"gross_charge":5860.34,"discounted_cash":5860.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESPIRATORY PANEL BIOFIRE - 22 TARGETS","code_information":[{"code":"3100202U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"gross_charge":2469.6,"discounted_cash":2469.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESPIRATORY PANEL GENMARK - 21 TARGETS","code_information":[{"code":"3100225U02","type":"CDM"},{"code":"0310","type":"RC"},{"code":"0225U","type":"HCPCS"}],"standard_charges":[{"gross_charge":1003.66,"discounted_cash":1003.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BCR-ABL1 MAJOR QUANTITATIVE PCR - ARUP","code_information":[{"code":"3108120605","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.99,"discounted_cash":749.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BCR-ABL1 MAJOR - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120607","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81206","type":"HCPCS"}],"standard_charges":[{"gross_charge":749.99,"discounted_cash":749.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BCR-ABL1 MINOR - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.06,"discounted_cash":128.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BCR/ABL T922 QNT MINOR BREAKPOINT","code_information":[{"code":"3108120703","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81207","type":"HCPCS"}],"standard_charges":[{"gross_charge":128.06,"discounted_cash":128.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BCR-ABL1 MICRO - BCR-ABL1 QUAL W/ REFLEX TO MAJOR OR MINOR QUANT - ARUP","code_information":[{"code":"3108120802","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81208","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.95,"discounted_cash":462.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CALR GENE ANALYSIS, COMMON, EXON 9 - MPN JAK2 REFLEX PANEL","code_information":[{"code":"3108121901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81219","type":"HCPCS"}],"standard_charges":[{"gross_charge":449.82,"discounted_cash":449.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOLECULAR PATHOLOGY - EGFR GENE ANALYSIS","code_information":[{"code":"3108123501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81235","type":"HCPCS"}],"standard_charges":[{"gross_charge":1065.18,"discounted_cash":1065.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FACTOR 5 LEIDEN","code_information":[{"code":"3108124102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81241","type":"HCPCS"}],"standard_charges":[{"gross_charge":71.51,"discounted_cash":71.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMOCHROMATOSIS (HFE) 3 MUTATION - ARUP","code_information":[{"code":"3108125602","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81256","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.98,"discounted_cash":226.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOLECULAR PATHOLOGY - JAK2 / V617F MUTATION GENE ANALYSIS","code_information":[{"code":"3108127001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.88,"discounted_cash":710.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JAK2 GENE V617F QUALITATIVE WITH REFLEX JAK2 EXON 12 - ARUP","code_information":[{"code":"3108127003","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.88,"discounted_cash":710.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JAK2 GENE V617F QUALITATIVE WITH REFLEX CALR AND MPL - ARUP","code_information":[{"code":"3108127004","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.88,"discounted_cash":710.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JAK2 EXON 14 V617F POINT MUTATION","code_information":[{"code":"3108127006","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81270","type":"HCPCS"}],"standard_charges":[{"gross_charge":710.88,"discounted_cash":710.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JAK2 TARGETED SEQUENCE EXONS 12-15 - MPN JAK2 REFLEX PANEL","code_information":[{"code":"3108127901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.84,"discounted_cash":225.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC JAK2 EXON 12 MUTATION PCR - ARUP","code_information":[{"code":"3108127902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81279","type":"HCPCS"}],"standard_charges":[{"gross_charge":500.0,"discounted_cash":500.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUDT15 VARIANTS - TPMT AND NUDT15 GENETICS - ARUP","code_information":[{"code":"3108130601","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81306","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.67,"discounted_cash":963.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPINAL MUSCULAR ATROPHY (SMA), COPY NUMBER ANALYSIS- ARUP","code_information":[{"code":"3108132902","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81329","type":"HCPCS"}],"standard_charges":[{"gross_charge":298.01,"discounted_cash":298.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MPL MUTATION DETECTION BY CAPILLARY ELECTROPHORESIS - ARUP","code_information":[{"code":"3108133803","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81338","type":"HCPCS"}],"standard_charges":[{"gross_charge":842.5,"discounted_cash":842.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MPL GENE SEQUENCE ANALYSIS, EXON 10 - MPN JAK2 REFLEX PANEL","code_information":[{"code":"3108133901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81339","type":"HCPCS"}],"standard_charges":[{"gross_charge":1087.5,"discounted_cash":1087.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC UGT1A1 GENOTYPING - ARUP","code_information":[{"code":"3108135002","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81350","type":"HCPCS"}],"standard_charges":[{"gross_charge":773.96,"discounted_cash":773.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANKLYOSING SPONDYLITIS (HLAB27) GENOTYPING - ARUP","code_information":[{"code":"3108137403","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.88,"discounted_cash":225.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HLA-B27 ANTIGEN","code_information":[{"code":"3108137404","type":"CDM"},{"code":"0300","type":"RC"},{"code":"81374","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.88,"discounted_cash":225.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APOLIPOPROTEIN E (APOE) MUTATION","code_information":[{"code":"3108140101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":355.17,"discounted_cash":355.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APOLIPOPROTEIN E (APOE) GENOTYPING, CARDIOVASCULAR RISK - ARUP","code_information":[{"code":"3108140102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81401","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.13,"discounted_cash":453.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 LEVEL 3","code_information":[{"code":"3108140201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.08,"discounted_cash":595.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MPL CODON 515 MUTATION - ARUP","code_information":[{"code":"3108140202","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81402","type":"HCPCS"}],"standard_charges":[{"gross_charge":595.08,"discounted_cash":595.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CADASIL (NOTCH3) FULL GENE SEQUENCING - ARUP","code_information":[{"code":"3108140603","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81406","type":"HCPCS"}],"standard_charges":[{"gross_charge":2250.0,"discounted_cash":2250.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOLECULAR PATHOLOGY - HEMATOLYMPHOID SEQUENCE VARIANTS","code_information":[{"code":"3108145001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81450","type":"HCPCS"}],"standard_charges":[{"gross_charge":7579.69,"discounted_cash":7579.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOLECULAR PATHOLOGY - TIER 2 UNLISTED","code_information":[{"code":"3108147901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81479","type":"HCPCS"}],"standard_charges":[{"gross_charge":729.09,"discounted_cash":729.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOLECULAR PATHOLOGY MAAA - OVARIAN ONCOLOGY","code_information":[{"code":"3108150301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81503","type":"HCPCS"}],"standard_charges":[{"gross_charge":1225.76,"discounted_cash":1225.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FETAL CONGENITAL ABNORM PANEL, MATERNAL SERUM","code_information":[{"code":"3108151101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81511","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.09,"discounted_cash":423.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MATERNAL SERUM SCREEN QUAD TEST - ARUP","code_information":[{"code":"3108151102","type":"CDM"},{"code":"0310","type":"RC"},{"code":"81511","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.09,"discounted_cash":423.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUK/LYMPH 16 OR MORE MARKERS - ARUP","code_information":[{"code":"3108818901","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88189","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.72,"discounted_cash":95.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE CULTURE, LYMPHOCYTE - CHROMOSOME ANALYSIS","code_information":[{"code":"3108823001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88230","type":"HCPCS"}],"standard_charges":[{"gross_charge":337.13,"discounted_cash":337.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TISSUE CULTURE NEOPLASTIC DISORDER - CHROMOSOME ANALYSIS - BONE MARROW, BLOOD CELLS","code_information":[{"code":"3108823701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88237","type":"HCPCS"}],"standard_charges":[{"gross_charge":897.69,"discounted_cash":897.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - 15 - 20 CELL 2 KAROTYPE BANDING","code_information":[{"code":"3108826201","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.18,"discounted_cash":363.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYTOGENETICS, DNA PROBE - FISH","code_information":[{"code":"3108827103","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88271","type":"HCPCS"}],"standard_charges":[{"gross_charge":75.97,"discounted_cash":75.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - INTERPHASE IN SITU HYBRID 100-300 CELL ANALYSIS","code_information":[{"code":"3108827502","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88275","type":"HCPCS"}],"standard_charges":[{"gross_charge":301.72,"discounted_cash":301.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS ADDITIONAL KARYOTYPE","code_information":[{"code":"3108828001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88280","type":"HCPCS"}],"standard_charges":[{"gross_charge":40.52,"discounted_cash":40.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - GENETIC STUDY INTERP & REPORT","code_information":[{"code":"3108829101","type":"CDM"},{"code":"0998","type":"RC"},{"code":"88291","type":"HCPCS"}],"standard_charges":[{"gross_charge":193.42,"discounted_cash":193.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY HISTOCHEMICAL STAIN ON FROZEN TISSUE","code_information":[{"code":"3108831401","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88314","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.06,"discounted_cash":48.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - INTRAOP CONSULT INITIAL SITE PREP EXAM","code_information":[{"code":"3108833301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88333","type":"HCPCS"}],"standard_charges":[{"gross_charge":226.82,"discounted_cash":226.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - ELECTRON MICROSCOPY","code_information":[{"code":"3108834801","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88348","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.41,"discounted_cash":983.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) MANUAL MORPHOMETRIC ANALYSIS EACH ANTIBODY","code_information":[{"code":"3108836001","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.12,"discounted_cash":568.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IHC STAIN SINGLE ABY QUANT/QUAL COMPUTER ASSIST","code_information":[{"code":"3108836101","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88361","type":"HCPCS"}],"standard_charges":[{"gross_charge":693.39,"discounted_cash":693.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EXAMINATION AND SELECTION OF ARCHIVED TISSUE FOR MOLECULAR ANALYSIS","code_information":[{"code":"3108836301","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88363","type":"HCPCS"}],"standard_charges":[{"gross_charge":64.85,"discounted_cash":64.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IN SITU HYBRIDIZATION EACH ADDITIONAL SINGLE PROBE STAIN","code_information":[{"code":"3108836401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88364","type":"HCPCS"}],"standard_charges":[{"gross_charge":136.97,"discounted_cash":136.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IN SITU HYBRIDIZATION INITIAL SINGLE PROBE STAIN","code_information":[{"code":"3108836501","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88365","type":"HCPCS"}],"standard_charges":[{"gross_charge":1032.52,"discounted_cash":1032.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB INITIAL STAIN COMPUTER ASSIST","code_information":[{"code":"3108836701","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88367","type":"HCPCS"}],"standard_charges":[{"gross_charge":211.07,"discounted_cash":211.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB MULTIPLX STAIN COMPUTER ASSIST","code_information":[{"code":"3108837401","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88374","type":"HCPCS"}],"standard_charges":[{"gross_charge":316.03,"discounted_cash":316.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - MORPH ANALYSIS IN SITU HYB MANUAL EACH MULTIPLEX STAIN PROCEDURE","code_information":[{"code":"3108837702","type":"CDM"},{"code":"0310","type":"RC"},{"code":"88377","type":"HCPCS"}],"standard_charges":[{"gross_charge":257.17,"discounted_cash":257.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CTYOPATHOLOGY SMEARS AND INTERPRETATION, FLUIDS","code_information":[{"code":"3118810401","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88104","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.27,"discounted_cash":17.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CYTOPATHOLOGY CONCENTRATION, SMEARS, AND INTERPRETATION, FLUIDS","code_information":[{"code":"3118810801","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88108","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.93,"discounted_cash":295.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAB CYTOPATH CELL ENHANCE TECH - ANAL PAP","code_information":[{"code":"3118811201","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88112","type":"HCPCS"}],"standard_charges":[{"gross_charge":130.0,"discounted_cash":130.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FINE NEEDLE ASPIRATION IMMEDIATE EVALUATION FOR ADEQUACY FIRST SITE","code_information":[{"code":"3118817201","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88172","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FINE NEEDLE ASPIRATION INTERPRETATION AND REPORT","code_information":[{"code":"3118817301","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88173","type":"HCPCS"}],"standard_charges":[{"gross_charge":162.0,"discounted_cash":162.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FINE NEEDLE ASPIRATION IMMEDIATE EVALUATION FOR ADEQUACY EACH ADDL SITE","code_information":[{"code":"3118817701","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88177","type":"HCPCS"}],"standard_charges":[{"gross_charge":36.86,"discounted_cash":36.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY FIRST MARKER","code_information":[{"code":"3118818405","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOWCYTOMETRY/ TECH COMPONENT, 1 MARKER - FLOWCYTOMETRY","code_information":[{"code":"3118818415","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.09,"discounted_cash":700.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LYMPHOCYTE SUBSETS FIRST MARKER","code_information":[{"code":"3118818421","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 35 MARKERS - ARUP","code_information":[{"code":"3118818423","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 10 MARKERS - ARUP","code_information":[{"code":"3118818424","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 11 MARKERS - ARUP","code_information":[{"code":"3118818425","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 12 MARKERS - ARUP","code_information":[{"code":"3118818426","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 13 MARKERS - ARUP","code_information":[{"code":"3118818427","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 14 MARKERS - ARUP","code_information":[{"code":"3118818428","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 15 MARKERS - ARUP","code_information":[{"code":"3118818429","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 16 MARKERS - ARUP","code_information":[{"code":"3118818430","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 17 MARKERS - ARUP","code_information":[{"code":"3118818431","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 18 MARKERS - ARUP","code_information":[{"code":"3118818432","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 19 MARKERS - ARUP","code_information":[{"code":"3118818433","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 20 MARKERS - ARUP","code_information":[{"code":"3118818434","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 21 MARKERS - ARUP","code_information":[{"code":"3118818435","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 22 MARKERS - ARUP","code_information":[{"code":"3118818436","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 23 MARKERS - ARUP","code_information":[{"code":"3118818437","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 24 MARKERS - ARUP","code_information":[{"code":"3118818438","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 25 MARKERS - ARUP","code_information":[{"code":"3118818439","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 26 MARKERS - ARUP","code_information":[{"code":"3118818440","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 27 MARKERS - ARUP","code_information":[{"code":"3118818441","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 28 MARKERS - ARUP","code_information":[{"code":"3118818442","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 29 MARKERS - ARUP","code_information":[{"code":"3118818443","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 30 MARKERS - ARUP","code_information":[{"code":"3118818444","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 31 MARKERS - ARUP","code_information":[{"code":"3118818445","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 32 MARKERS - ARUP","code_information":[{"code":"3118818446","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 33 MARKERS - ARUP","code_information":[{"code":"3118818447","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 34 MARKERS - ARUP","code_information":[{"code":"3118818448","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 5 MARKERS - ARUP","code_information":[{"code":"3118818449","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 6 MARKERS - ARUP","code_information":[{"code":"3118818450","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 7 MARKERS - ARUP","code_information":[{"code":"3118818451","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 8 MARKERS - ARUP","code_information":[{"code":"3118818452","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 1ST OF 9 MARKERS - ARUP","code_information":[{"code":"3118818453","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88184","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.82,"discounted_cash":983.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - LAB FLOWCYTOMETRY/TECH CMP","code_information":[{"code":"3118818501","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.42,"discounted_cash":17.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOWCYTOMETRY/TECH COMPONENT, ADD-ON - BUNDLED CHARGE","code_information":[{"code":"3118818502","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY  EACH ADDITIONAL MARKER","code_information":[{"code":"3118818505","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":45.92,"discounted_cash":45.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LYMPHOCYTE SUBSETS ADDITIONAL MARKERS","code_information":[{"code":"3118818507","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":17.42,"discounted_cash":17.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 34 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818510","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 9 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818511","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 10 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818512","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 11 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818513","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 12 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818514","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 13 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818515","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 14 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818516","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 15 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818517","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 16 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818518","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 17 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818519","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 18 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818520","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 19 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818521","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 20 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818522","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 21 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818523","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 22 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818524","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 23 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818525","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 24 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818526","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 25 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818527","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 26 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818528","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 27 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818529","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 28 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818530","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 29 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818531","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 30 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818532","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 31 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818533","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 32 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818534","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 33 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818535","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 4 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818536","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 5 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818537","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 6 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818538","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 7 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818539","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLOW CYTOMETRY LEUKEMIA/LYMPHOMA PHENOTYPE 8 ADDITIONAL MARKERS - ARUP","code_information":[{"code":"3118818540","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88185","type":"HCPCS"}],"standard_charges":[{"gross_charge":42.05,"discounted_cash":42.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHROMOSOME COUNT - CHROMOSOME ANALYSIS PRODUCTS OF CONCEPTION - ARUP","code_information":[{"code":"3118826202","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88262","type":"HCPCS"}],"standard_charges":[{"gross_charge":363.18,"discounted_cash":363.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY - CHROM ANALYSIS 20 - 25 CELL","code_information":[{"code":"3118826401","type":"CDM"},{"code":"0311","type":"RC"},{"code":"88264","type":"HCPCS"}],"standard_charges":[{"gross_charge":206.8,"discounted_cash":206.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL I GROSS ONLY","code_information":[{"code":"3128830001","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88300","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.86,"discounted_cash":146.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL II","code_information":[{"code":"3128830201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88302","type":"HCPCS"}],"standard_charges":[{"gross_charge":295.93,"discounted_cash":295.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURG PATH,LEVEL III - LAB SURG PATH,LEVEL III","code_information":[{"code":"3128830401","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88304","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.78,"discounted_cash":401.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL IV","code_information":[{"code":"3128830501","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88305","type":"HCPCS"}],"standard_charges":[{"gross_charge":419.08,"discounted_cash":419.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL V","code_information":[{"code":"3128830701","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88307","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.89,"discounted_cash":632.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY LEVEL VI","code_information":[{"code":"3128830901","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88309","type":"HCPCS"}],"standard_charges":[{"gross_charge":909.39,"discounted_cash":909.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY DECALCIFY TISSUE","code_information":[{"code":"3128831105","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88311","type":"HCPCS"}],"standard_charges":[{"gross_charge":84.23,"discounted_cash":84.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPECIAL STAINS,GROUP I - LAB SPECIAL STAINS,GROUP I","code_information":[{"code":"3128831201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.86,"discounted_cash":213.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY SPECIAL STAIN GROUP I MICROORGANISMS","code_information":[{"code":"3128831202","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88312","type":"HCPCS"}],"standard_charges":[{"gross_charge":213.86,"discounted_cash":213.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPECIAL STAINS,GROUP II - LAB SPECIAL STAINS,GROUP II","code_information":[{"code":"3128831301","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.08,"discounted_cash":244.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY SPECIAL STAIN GROUP II EXCEPT MICROORGANISMS","code_information":[{"code":"3128831302","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88313","type":"HCPCS"}],"standard_charges":[{"gross_charge":244.08,"discounted_cash":244.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY SPECIAL STAIN FOR ENZYME CONSTITUENTS","code_information":[{"code":"3128831901","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88319","type":"HCPCS"}],"standard_charges":[{"gross_charge":48.06,"discounted_cash":48.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY CONSULT ON SLIDES PREPARED ELSEWHERE","code_information":[{"code":"3128832101","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88321","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.6,"discounted_cash":453.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MICROSLIDE CONSULT W SLIDE PREP - LAB MICROSLIDE CONSULT W SLD PREP","code_information":[{"code":"3128832301","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88323","type":"HCPCS"}],"standard_charges":[{"gross_charge":468.74,"discounted_cash":468.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC COMPREHENSIVE PATHOLOGY CONSULT","code_information":[{"code":"3128832501","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88325","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.66,"discounted_cash":548.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, FROZEN SECTION BLOCK","code_information":[{"code":"3128833101","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88331","type":"HCPCS"}],"standard_charges":[{"gross_charge":313.23,"discounted_cash":313.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, EACH ADDITIONAL FROZEN SECTION BLOCK","code_information":[{"code":"3128833201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88332","type":"HCPCS"}],"standard_charges":[{"gross_charge":209.53,"discounted_cash":209.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGY CONSULT IN SURGERY, EACH ADDITIONAL CYTOLOGIC EXAMINATION","code_information":[{"code":"3128833401","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88334","type":"HCPCS"}],"standard_charges":[{"gross_charge":205.2,"discounted_cash":205.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) EACH ADDITIONAL ANTIBODY","code_information":[{"code":"3128834101","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88341","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.48,"discounted_cash":74.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOHISTOCHEMISTRY (IHC) FIRST ANTIBODY","code_information":[{"code":"3128834201","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.69,"discounted_cash":354.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMHISTOCHEM/CYTCHM INIT ANTIBODY STAIN PROCEDURE - SINGLE ABY","code_information":[{"code":"3128834203","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88342","type":"HCPCS"}],"standard_charges":[{"gross_charge":503.8,"discounted_cash":503.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFLUORESCENT STUDY,INDIRECT - ANTIBODY EACH","code_information":[{"code":"3128834602","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88346","type":"HCPCS"}],"standard_charges":[{"gross_charge":1566.83,"discounted_cash":1566.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNOFLUORESCENT STUDY,INDIRECT ADDITIONAL SINGLE ABY STAIN","code_information":[{"code":"3128835001","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88350","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.89,"discounted_cash":105.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PD-L1 22C3 IHC WITH TUMOR PROPORTION SCORE - ARUP","code_information":[{"code":"3128836006","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.12,"discounted_cash":568.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PD-L1 22C3 IHC WITH COMBINED POSITIVE SCORE - ARUP","code_information":[{"code":"3128836007","type":"CDM"},{"code":"0312","type":"RC"},{"code":"88360","type":"HCPCS"}],"standard_charges":[{"gross_charge":568.12,"discounted_cash":568.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SURGICAL PATHOLOGY PROSTATE NEEDLE BIOPSY, ANY NUMBER OF SPECIMENS","code_information":[{"code":"312G041601","type":"CDM"},{"code":"0312","type":"RC"},{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"gross_charge":533.22,"discounted_cash":533.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY EYE FOR FOREIGN BODY","code_information":[{"code":"3207003001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70030","type":"HCPCS"}],"standard_charges":[{"gross_charge":339.75,"discounted_cash":339.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY JAW <4 VW","code_information":[{"code":"3207010001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70100","type":"HCPCS"}],"standard_charges":[{"gross_charge":554.83,"discounted_cash":554.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY JAW 4+ VW","code_information":[{"code":"3207011001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1155.87,"discounted_cash":1155.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY FACIAL BONES <3 VW","code_information":[{"code":"3207014001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70140","type":"HCPCS"}],"standard_charges":[{"gross_charge":514.9,"discounted_cash":514.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY FACIAL BONES 3+ VW","code_information":[{"code":"3207015001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70150","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.77,"discounted_cash":1277.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY NASAL BONES","code_information":[{"code":"3207016001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70160","type":"HCPCS"}],"standard_charges":[{"gross_charge":849.02,"discounted_cash":849.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY ORBITS","code_information":[{"code":"3207020001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70200","type":"HCPCS"}],"standard_charges":[{"gross_charge":504.4,"discounted_cash":504.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SINUSES <3 VW - XR PARANASAL SINUSES 1-2 VIEWS","code_information":[{"code":"3207021002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70210","type":"HCPCS"}],"standard_charges":[{"gross_charge":794.4,"discounted_cash":794.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SINUSES 3+ VW","code_information":[{"code":"3207022001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70220","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.61,"discounted_cash":1191.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SKULL <4 VW","code_information":[{"code":"3207025001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70250","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.31,"discounted_cash":668.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SKULL 4+ VW","code_information":[{"code":"3207026001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70260","type":"HCPCS"}],"standard_charges":[{"gross_charge":1178.98,"discounted_cash":1178.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY TMJ UNILAT","code_information":[{"code":"3207032802","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70328","type":"HCPCS"}],"standard_charges":[{"gross_charge":1069.7,"discounted_cash":1069.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY TMJ BILAT","code_information":[{"code":"3207033001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70330","type":"HCPCS"}],"standard_charges":[{"gross_charge":1069.7,"discounted_cash":1069.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY NECK SOFT TISSUE","code_information":[{"code":"3207036001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"70360","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.48,"discounted_cash":558.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY RIBS 2 VW UNILAT","code_information":[{"code":"3207110001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71100","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.24,"discounted_cash":977.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY RIBS 3 VW BILAT","code_information":[{"code":"3207111001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71110","type":"HCPCS"}],"standard_charges":[{"gross_charge":1191.61,"discounted_cash":1191.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY STERNUM 2+ VW","code_information":[{"code":"3207112001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71120","type":"HCPCS"}],"standard_charges":[{"gross_charge":701.93,"discounted_cash":701.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY STERNO-CLAVICLUAR JT","code_information":[{"code":"3207113001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"71130","type":"HCPCS"}],"standard_charges":[{"gross_charge":517.0,"discounted_cash":517.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SPINE ONE VIEW","code_information":[{"code":"3207202001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72020","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.23,"discounted_cash":273.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX SPINE CERVICAL 2 OR 3 VIEWS","code_information":[{"code":"3207204002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1019.28,"discounted_cash":1019.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX SPINE CERVICAL 4 OR 5 VIEWS","code_information":[{"code":"3207205001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72050","type":"HCPCS"}],"standard_charges":[{"gross_charge":2303.34,"discounted_cash":2303.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX SPINE CERVICAL 6 OR MORE VIEWS","code_information":[{"code":"3207205201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2437.86,"discounted_cash":2437.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY THORACIC SPINE 2 VW","code_information":[{"code":"3207207001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1006.66,"discounted_cash":1006.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY THORACIC SPINE+SWIM 3 VW","code_information":[{"code":"3207207201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72072","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.09,"discounted_cash":1181.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY THORACIC SPINE 4 VW","code_information":[{"code":"3207207401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1214.72,"discounted_cash":1214.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS","code_information":[{"code":"3207208001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72080","type":"HCPCS"}],"standard_charges":[{"gross_charge":779.7,"discounted_cash":779.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 1 VW","code_information":[{"code":"3207208101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72081","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.57,"discounted_cash":453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 4/5 VW","code_information":[{"code":"3207208301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72083","type":"HCPCS"}],"standard_charges":[{"gross_charge":758.69,"discounted_cash":758.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX ENTIR THRC LMBR CRV SAC SPI W/SKULL 6/> VW","code_information":[{"code":"3207208401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72084","type":"HCPCS"}],"standard_charges":[{"gross_charge":912.1,"discounted_cash":912.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY LUMBAR SPINE 2/3 VW","code_information":[{"code":"3207210001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72100","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.89,"discounted_cash":949.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY LUMBAR SPINE 4 VW","code_information":[{"code":"3207211001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72110","type":"HCPCS"}],"standard_charges":[{"gross_charge":2303.34,"discounted_cash":2303.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY LUMBAR SPINE 6+ VW","code_information":[{"code":"3207211401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72114","type":"HCPCS"}],"standard_charges":[{"gross_charge":2437.86,"discounted_cash":2437.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY LUMBAR SPINE FLEX/EXTEN","code_information":[{"code":"3207212001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72120","type":"HCPCS"}],"standard_charges":[{"gross_charge":760.76,"discounted_cash":760.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY PELVIS 1/2 VW","code_information":[{"code":"3207217001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72170","type":"HCPCS"}],"standard_charges":[{"gross_charge":777.6,"discounted_cash":777.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY PELVIS 3+ VW","code_information":[{"code":"3207219001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72190","type":"HCPCS"}],"standard_charges":[{"gross_charge":790.19,"discounted_cash":790.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SACROILIAC JTS <3 VW","code_information":[{"code":"3207220001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72200","type":"HCPCS"}],"standard_charges":[{"gross_charge":453.11,"discounted_cash":453.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SACROILIAC JTS 3+ VW","code_information":[{"code":"3207220201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72202","type":"HCPCS"}],"standard_charges":[{"gross_charge":926.79,"discounted_cash":926.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SACRUM/COCCYX 2+ VW","code_information":[{"code":"3207222001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72220","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.24,"discounted_cash":977.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOGRAPHY CERV SPINE","code_information":[{"code":"3207224001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1495.86,"discounted_cash":1495.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOGRAPHY OF ENTIRE SPINE","code_information":[{"code":"3207227004","type":"CDM"},{"code":"0320","type":"RC"},{"code":"72270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1997.79,"discounted_cash":1997.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY CLAVICLE","code_information":[{"code":"3207300001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73000","type":"HCPCS"}],"standard_charges":[{"gross_charge":556.91,"discounted_cash":556.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SCAPULA","code_information":[{"code":"3207301001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73010","type":"HCPCS"}],"standard_charges":[{"gross_charge":628.39,"discounted_cash":628.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SHOULDER 1 VW","code_information":[{"code":"3207302002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73020","type":"HCPCS"}],"standard_charges":[{"gross_charge":264.16,"discounted_cash":264.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY SHOULDER 2+ VW","code_information":[{"code":"3207303002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73030","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.62,"discounted_cash":819.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY AC JTS","code_information":[{"code":"3207305001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73050","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.31,"discounted_cash":668.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY HUMERUS","code_information":[{"code":"3207306002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73060","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.05,"discounted_cash":601.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY ELBOW 2 VW","code_information":[{"code":"3207307002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73070","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.25,"discounted_cash":605.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY ELBOW 3+ VW","code_information":[{"code":"3207308002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73080","type":"HCPCS"}],"standard_charges":[{"gross_charge":764.98,"discounted_cash":764.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY FOREARM 2 VW","code_information":[{"code":"3207309001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73090","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.98,"discounted_cash":600.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY ARM, INFANT","code_information":[{"code":"3207309201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73092","type":"HCPCS"}],"standard_charges":[{"gross_charge":653.61,"discounted_cash":653.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY WRIST 2 VW","code_information":[{"code":"3207310001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73100","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.05,"discounted_cash":601.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY WRIST 3+ VW","code_information":[{"code":"3207311001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73110","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.55,"discounted_cash":838.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY HAND 2 VW","code_information":[{"code":"3207312001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73120","type":"HCPCS"}],"standard_charges":[{"gross_charge":632.58,"discounted_cash":632.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY HAND 3+ VW","code_information":[{"code":"3207313001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73130","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.44,"discounted_cash":857.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY EXAM OF FINGER(S)","code_information":[{"code":"3207314002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73140","type":"HCPCS"}],"standard_charges":[{"gross_charge":596.85,"discounted_cash":596.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS 1 VIEW","code_information":[{"code":"3207350101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73501","type":"HCPCS"}],"standard_charges":[{"gross_charge":273.23,"discounted_cash":273.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS","code_information":[{"code":"3207350201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73502","type":"HCPCS"}],"standard_charges":[{"gross_charge":1256.77,"discounted_cash":1256.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX HIP UNILATERAL WITH PELVIS MINIMUM 4 VIEWS","code_information":[{"code":"3207350301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73503","type":"HCPCS"}],"standard_charges":[{"gross_charge":1862.07,"discounted_cash":1862.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX HIPS BILATERAL WITH PELVIS 2 VIEWS","code_information":[{"code":"3207352101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73521","type":"HCPCS"}],"standard_charges":[{"gross_charge":1122.26,"discounted_cash":1122.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY EXAM HIPS BI 3-4 VWS - XR HIPS BILAT 3-4 VW W/ OR W/O PELVIS","code_information":[{"code":"3207352201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73522","type":"HCPCS"}],"standard_charges":[{"gross_charge":270.0,"discounted_cash":270.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADEX HIPS BILATERAL WITH PELVIS MINIMUM 5 VIEWS","code_information":[{"code":"3207352301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73523","type":"HCPCS"}],"standard_charges":[{"gross_charge":974.61,"discounted_cash":974.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAMINATION FEMUR 1 VIEW","code_information":[{"code":"3207355101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73551","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.63,"discounted_cash":529.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAMINATION FEMUR MINIMUM 2 VIEWS","code_information":[{"code":"3207355201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73552","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.6,"discounted_cash":943.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY KNEE 1 OR 2 VIEW","code_information":[{"code":"3207356001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1008.78,"discounted_cash":1008.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY KNEE 3 VIEW","code_information":[{"code":"3207356201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73562","type":"HCPCS"}],"standard_charges":[{"gross_charge":994.02,"discounted_cash":994.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY KNEE 4+ VIEW","code_information":[{"code":"3207356401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73564","type":"HCPCS"}],"standard_charges":[{"gross_charge":1092.8,"discounted_cash":1092.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY KNEE BILAT STANDING","code_information":[{"code":"3207356501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73565","type":"HCPCS"}],"standard_charges":[{"gross_charge":479.17,"discounted_cash":479.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY TIB + FIB, 2VW","code_information":[{"code":"3207359001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73590","type":"HCPCS"}],"standard_charges":[{"gross_charge":987.76,"discounted_cash":987.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY LEG, INFANT","code_information":[{"code":"3207359201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73592","type":"HCPCS"}],"standard_charges":[{"gross_charge":1023.49,"discounted_cash":1023.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY ANKLE 2 VW","code_information":[{"code":"3207360001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73600","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.25,"discounted_cash":605.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY ANKLE 3+ VW","code_information":[{"code":"3207361001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73610","type":"HCPCS"}],"standard_charges":[{"gross_charge":796.48,"discounted_cash":796.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY FOOT 2 VW","code_information":[{"code":"3207362001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73620","type":"HCPCS"}],"standard_charges":[{"gross_charge":526.95,"discounted_cash":526.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY FOOT 3+ VW","code_information":[{"code":"3207363001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73630","type":"HCPCS"}],"standard_charges":[{"gross_charge":767.08,"discounted_cash":767.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY HEEL","code_information":[{"code":"3207365001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73650","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.63,"discounted_cash":529.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY TOE(S)","code_information":[{"code":"3207366001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"73660","type":"HCPCS"}],"standard_charges":[{"gross_charge":529.63,"discounted_cash":529.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 1 VIEW","code_information":[{"code":"3207401802","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74018","type":"HCPCS"}],"standard_charges":[{"gross_charge":445.22,"discounted_cash":445.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 2 VIEWS","code_information":[{"code":"3207401901","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74019","type":"HCPCS"}],"standard_charges":[{"gross_charge":681.04,"discounted_cash":681.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM ABDOMEN 3+ VIEWS","code_information":[{"code":"3207402101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74021","type":"HCPCS"}],"standard_charges":[{"gross_charge":589.52,"discounted_cash":589.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM COMPLETE ACUTE ABD SERIES W/CHEST","code_information":[{"code":"3207402201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74022","type":"HCPCS"}],"standard_charges":[{"gross_charge":983.55,"discounted_cash":983.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY PERITONEUM - XR GUIDED PERITONEOGRAM W CONTRAST","code_information":[{"code":"3207419001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74190","type":"HCPCS"}],"standard_charges":[{"gross_charge":741.18,"discounted_cash":741.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM ESOPHAGUS SINGLE CONTRAST STUDY","code_information":[{"code":"3207422001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74220","type":"HCPCS"}],"standard_charges":[{"gross_charge":932.35,"discounted_cash":932.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM SWALLOW FUNCTION CONTRAST STUDY","code_information":[{"code":"3207423001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74230","type":"HCPCS"}],"standard_charges":[{"gross_charge":918.39,"discounted_cash":918.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM UPR GI TRC SINGLE CONTRAST STUDY","code_information":[{"code":"3207424001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74240","type":"HCPCS"}],"standard_charges":[{"gross_charge":1150.51,"discounted_cash":1150.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY","code_information":[{"code":"3207424601","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1532.72,"discounted_cash":1532.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CXR SM BOWEL W/MLT IMG","code_information":[{"code":"3207424801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74248","type":"HCPCS"}],"standard_charges":[{"gross_charge":613.08,"discounted_cash":613.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM SMALL INT SINGLE CONTRAST STUDY","code_information":[{"code":"3207425001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74250","type":"HCPCS"}],"standard_charges":[{"gross_charge":1046.5,"discounted_cash":1046.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM COLON SINGLE CONTRAST STUDY","code_information":[{"code":"3207427001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74270","type":"HCPCS"}],"standard_charges":[{"gross_charge":1142.2,"discounted_cash":1142.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY","code_information":[{"code":"3207428001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1959.33,"discounted_cash":1959.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC XR CHOLECYSTOGRAM","code_information":[{"code":"3207429001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74290","type":"HCPCS"}],"standard_charges":[{"gross_charge":887.95,"discounted_cash":887.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY OPER CHOLANGIOGRAM","code_information":[{"code":"3207430001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1580.81,"discounted_cash":1580.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY OPER CHOLANGIO ADDNL SET","code_information":[{"code":"3207430101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74301","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.6,"discounted_cash":305.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY FOR BILE DUCT ENDOSCOPY","code_information":[{"code":"3207432801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74328","type":"HCPCS"}],"standard_charges":[{"gross_charge":2955.28,"discounted_cash":2955.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY FOR PANCREAS ENDOSCOPY","code_information":[{"code":"3207432901","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74329","type":"HCPCS"}],"standard_charges":[{"gross_charge":4299.34,"discounted_cash":4299.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY BILE/PANCREAS ENDOSCOPY","code_information":[{"code":"3207433001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74330","type":"HCPCS"}],"standard_charges":[{"gross_charge":4284.77,"discounted_cash":4284.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY GUIDE, GI DILATION","code_information":[{"code":"3207436001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74360","type":"HCPCS"}],"standard_charges":[{"gross_charge":769.38,"discounted_cash":769.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY CYSTOGRAM, MIN 3 VIEW","code_information":[{"code":"3207443001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1399.3,"discounted_cash":1399.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY URETHROCYSTOGRAM","code_information":[{"code":"3207445001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1189.88,"discounted_cash":1189.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY URETHROCYSTOGRAM+VOIDING","code_information":[{"code":"3207445501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74455","type":"HCPCS"}],"standard_charges":[{"gross_charge":2645.01,"discounted_cash":2645.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY HYSTEROSALPINGOGRAM","code_information":[{"code":"3207474001","type":"CDM"},{"code":"0320","type":"RC"},{"code":"74740","type":"HCPCS"}],"standard_charges":[{"gross_charge":1244.88,"discounted_cash":1244.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL INTRALUM OBSTR MATERIAL","code_information":[{"code":"3207590201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"75902","type":"HCPCS"}],"standard_charges":[{"gross_charge":619.99,"discounted_cash":619.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME","code_information":[{"code":"3207600004","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76000","type":"HCPCS"}],"standard_charges":[{"gross_charge":977.56,"discounted_cash":977.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY NOSE-RECTUM CHILD F.B.","code_information":[{"code":"3207601002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76010","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.46,"discounted_cash":482.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY FISTULA,ABSCESS,SINUS TRACT","code_information":[{"code":"3207608005","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76080","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.46,"discounted_cash":890.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC XR EXAM  BREAST SPECIMEN","code_information":[{"code":"3207609801","type":"CDM"},{"code":"0320","type":"RC"},{"code":"76098","type":"HCPCS"}],"standard_charges":[{"gross_charge":1360.16,"discounted_cash":1360.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUOROGUIDE CNTRL VEN ACCESS,PLACE,REPLACE,REMOVE","code_information":[{"code":"3207700101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77001","type":"HCPCS"}],"standard_charges":[{"gross_charge":813.99,"discounted_cash":813.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT","code_information":[{"code":"3207700201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.06,"discounted_cash":410.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEEDLE LOCALIZATION BY XRAY - FL GUIDED BIOPSY/ASP/INJ","code_information":[{"code":"3207700293","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77002","type":"HCPCS"}],"standard_charges":[{"gross_charge":410.06,"discounted_cash":410.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FLUORSCOPIC GUIDANCE SPINAL INJECTION","code_information":[{"code":"3207700301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77003","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.68,"discounted_cash":557.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAYS FOR BONE AGE","code_information":[{"code":"3207707201","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77072","type":"HCPCS"}],"standard_charges":[{"gross_charge":592.65,"discounted_cash":592.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAYS, BONE LENGTH STUDIES","code_information":[{"code":"3207707301","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77073","type":"HCPCS"}],"standard_charges":[{"gross_charge":470.35,"discounted_cash":470.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAYS, BONE SURVEY, LIMITED","code_information":[{"code":"3207707401","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77074","type":"HCPCS"}],"standard_charges":[{"gross_charge":1875.38,"discounted_cash":1875.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAYS, BONE SURVEY COMPLETE","code_information":[{"code":"3207707501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77075","type":"HCPCS"}],"standard_charges":[{"gross_charge":2133.13,"discounted_cash":2133.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAYS, BONE SURVEY, INFANT","code_information":[{"code":"3207707601","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77076","type":"HCPCS"}],"standard_charges":[{"gross_charge":949.89,"discounted_cash":949.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DEXA,BONE DENSITY, 1 + SITE, AXIAL SKELETON","code_information":[{"code":"3207708002","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77080","type":"HCPCS"}],"standard_charges":[{"gross_charge":605.25,"discounted_cash":605.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DEXA,BONE DENSITY, 1 + SITE, APPENDICULR SKELTN","code_information":[{"code":"3207708101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77081","type":"HCPCS"}],"standard_charges":[{"gross_charge":548.52,"discounted_cash":548.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DXA BONE DENSITY STUDY AXIAL SKELETON","code_information":[{"code":"3207708501","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77085","type":"HCPCS"}],"standard_charges":[{"gross_charge":550.85,"discounted_cash":550.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TBS TECHNICAL CALCULATION ONLY","code_information":[{"code":"3207709101","type":"CDM"},{"code":"0320","type":"RC"},{"code":"77091","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.01,"discounted_cash":210.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARTHROGRAM OF SHOULDER","code_information":[{"code":"3227304001","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73040","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.37,"discounted_cash":928.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARTHROGRAM OF HIP","code_information":[{"code":"3227352501","type":"CDM"},{"code":"0322","type":"RC"},{"code":"73525","type":"HCPCS"}],"standard_charges":[{"gross_charge":944.76,"discounted_cash":944.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO AORTOGRAM ABD SERIAL","code_information":[{"code":"3237562501","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75625","type":"HCPCS"}],"standard_charges":[{"gross_charge":9453.57,"discounted_cash":9453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO AORTOBIFEMORAL W CATH","code_information":[{"code":"3237563001","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75630","type":"HCPCS"}],"standard_charges":[{"gross_charge":9453.57,"discounted_cash":9453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO EXTREMITY UNILAT","code_information":[{"code":"3237571001","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75710","type":"HCPCS"}],"standard_charges":[{"gross_charge":9453.57,"discounted_cash":9453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO EXTERMITY BILAT","code_information":[{"code":"3237571601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75716","type":"HCPCS"}],"standard_charges":[{"gross_charge":9453.57,"discounted_cash":9453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO VISCERAL SELECTV/SUBSELEC","code_information":[{"code":"3237572601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75726","type":"HCPCS"}],"standard_charges":[{"gross_charge":19659.49,"discounted_cash":19659.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO PELVIS","code_information":[{"code":"3237573601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75736","type":"HCPCS"}],"standard_charges":[{"gross_charge":9453.57,"discounted_cash":9453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO PULMON UNILAT SELECT","code_information":[{"code":"3237574101","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75741","type":"HCPCS"}],"standard_charges":[{"gross_charge":9453.57,"discounted_cash":9453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO PULMON BILAT SELECT","code_information":[{"code":"3237574302","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75743","type":"HCPCS"}],"standard_charges":[{"gross_charge":9453.57,"discounted_cash":9453.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO INTERN MAMMARY","code_information":[{"code":"3237575601","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75756","type":"HCPCS"}],"standard_charges":[{"gross_charge":4924.85,"discounted_cash":4924.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANGIO EA ADDNL SELECTV VESSEL","code_information":[{"code":"3237577401","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75774","type":"HCPCS"}],"standard_charges":[{"gross_charge":3444.46,"discounted_cash":3444.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VENOGRAM EXTREM UNILAT","code_information":[{"code":"3237582007","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75820","type":"HCPCS"}],"standard_charges":[{"gross_charge":3055.36,"discounted_cash":3055.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VENOGRAM EXTREM BILAT","code_information":[{"code":"3237582201","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2717.91,"discounted_cash":2717.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VENOGRAM INFER VENA CAVA","code_information":[{"code":"3237582501","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75825","type":"HCPCS"}],"standard_charges":[{"gross_charge":9669.9,"discounted_cash":9669.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VENOGRAM SUPER VENA CAVA","code_information":[{"code":"3237582701","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75827","type":"HCPCS"}],"standard_charges":[{"gross_charge":3485.17,"discounted_cash":3485.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHANGE PERCUT TUBE/DRAIN CATH W CONTRAST MONIT","code_information":[{"code":"3237598401","type":"CDM"},{"code":"0323","type":"RC"},{"code":"75984","type":"HCPCS"}],"standard_charges":[{"gross_charge":2140.83,"discounted_cash":2140.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM CHEST SINGLE VIEW","code_information":[{"code":"3247104502","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71045","type":"HCPCS"}],"standard_charges":[{"gross_charge":736.64,"discounted_cash":736.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM CHEST 2 VIEWS","code_information":[{"code":"3247104606","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71046","type":"HCPCS"}],"standard_charges":[{"gross_charge":1257.74,"discounted_cash":1257.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC XR CHEST 2V W AP LORDOTIC","code_information":[{"code":"3247104701","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71047","type":"HCPCS"}],"standard_charges":[{"gross_charge":972.74,"discounted_cash":972.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIOLOGIC EXAM CHEST 4+ VIEWS","code_information":[{"code":"3247104803","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71048","type":"HCPCS"}],"standard_charges":[{"gross_charge":1334.67,"discounted_cash":1334.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY RIBS, CHEST 3+ VW","code_information":[{"code":"3247110101","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1076.02,"discounted_cash":1076.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC X-RAY RIBS, CHEST 4+ VW","code_information":[{"code":"3247111101","type":"CDM"},{"code":"0324","type":"RC"},{"code":"71111","type":"HCPCS"}],"standard_charges":[{"gross_charge":1477.39,"discounted_cash":1477.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ CHEMO, NON-HORMONAL ANTI-NEOPL, SUBQ/IM","code_information":[{"code":"3319640101","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96401","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.45,"discounted_cash":143.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ CHEMO, HORMONAL ANTI-NEOPL, SUBQ/IM","code_information":[{"code":"3319640201","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96402","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.45,"discounted_cash":143.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ CHEMO, CNS, W/ SPINAL PUNCTURE","code_information":[{"code":"3319645001","type":"CDM"},{"code":"0331","type":"RC"},{"code":"96450","type":"HCPCS"}],"standard_charges":[{"gross_charge":958.87,"discounted_cash":958.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR SIMULATION SIMPLE","code_information":[{"code":"3337728001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77280","type":"HCPCS"}],"standard_charges":[{"gross_charge":1454.84,"discounted_cash":1454.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR SIMULATION COMPLEX","code_information":[{"code":"3337729001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2621.66,"discounted_cash":2621.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR SIMULATION RESPIRATORY MOTION","code_information":[{"code":"3337729301","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77293","type":"HCPCS"}],"standard_charges":[{"gross_charge":1410.43,"discounted_cash":1410.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC 3D RXTHPY PLAN W/ HISTOGM","code_information":[{"code":"3337729501","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77295","type":"HCPCS"}],"standard_charges":[{"gross_charge":5794.1,"discounted_cash":5794.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIATION THERAPY,DOSIMETRY PLAN","code_information":[{"code":"3337730002","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77300","type":"HCPCS"}],"standard_charges":[{"gross_charge":1009.14,"discounted_cash":1009.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIATION THERAPY INTENSITY MODULATED THERAPY PLAN - IMRT","code_information":[{"code":"3337730101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77301","type":"HCPCS"}],"standard_charges":[{"gross_charge":14775.41,"discounted_cash":14775.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIATION THERAPY - TELETHERAPY ISODOSE PLAN SIMPLE","code_information":[{"code":"3337730601","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77306","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.61,"discounted_cash":459.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIATION THERAPY - TELETHERAPY ISODOSE PLAN COMPLEX","code_information":[{"code":"3337730701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77307","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.61,"discounted_cash":459.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIATION THERAPY - BRACHYTHERAPY ISODOSE PLAN SIMPLE","code_information":[{"code":"3337731601","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77316","type":"HCPCS"}],"standard_charges":[{"gross_charge":459.61,"discounted_cash":459.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIATION THERAPY - BRACHYTHERAPY ISODOSE PLAN INTERMEDIATE","code_information":[{"code":"3337731701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77317","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.55,"discounted_cash":1277.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIATION THERAPY - BRACHYTHERAPY ISODOSE PLAN COMPLEX","code_information":[{"code":"3337731801","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77318","type":"HCPCS"}],"standard_charges":[{"gross_charge":1277.55,"discounted_cash":1277.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR SPECIAL PORT PLAN","code_information":[{"code":"3337732101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77321","type":"HCPCS"}],"standard_charges":[{"gross_charge":2119.18,"discounted_cash":2119.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR SPECIAL DOSIMETRY W DEVICE","code_information":[{"code":"3337733101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77331","type":"HCPCS"}],"standard_charges":[{"gross_charge":819.89,"discounted_cash":819.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR TREATMENT DEVICE SIMPLE","code_information":[{"code":"3337733201","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77332","type":"HCPCS"}],"standard_charges":[{"gross_charge":616.0,"discounted_cash":616.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR TREATMENT DEVICE INTERMEDIATE","code_information":[{"code":"3337733301","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77333","type":"HCPCS"}],"standard_charges":[{"gross_charge":817.81,"discounted_cash":817.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR TREATMENT DEVICE COMPLEX","code_information":[{"code":"3337733401","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77334","type":"HCPCS"}],"standard_charges":[{"gross_charge":1946.79,"discounted_cash":1946.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR PHYSICS CONSULT PER WEEK","code_information":[{"code":"3337733601","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77336","type":"HCPCS"}],"standard_charges":[{"gross_charge":960.77,"discounted_cash":960.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR TREATMENT DEVICE MLC FOR IMRT PER PLAN","code_information":[{"code":"3337733801","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77338","type":"HCPCS"}],"standard_charges":[{"gross_charge":2066.62,"discounted_cash":2066.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR PHYSICS CONSULT SPECIAL","code_information":[{"code":"3337737001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77370","type":"HCPCS"}],"standard_charges":[{"gross_charge":1501.1,"discounted_cash":1501.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR SRS 1 SESSION MULTI COBALT 60","code_information":[{"code":"3337737101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77371","type":"HCPCS"}],"standard_charges":[{"gross_charge":26271.41,"discounted_cash":26271.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR SBRT PER SESSION MAX OF 5","code_information":[{"code":"3337737301","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77373","type":"HCPCS"}],"standard_charges":[{"gross_charge":5994.68,"discounted_cash":5994.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR IMRT SIMPLE","code_information":[{"code":"3337738501","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2062.18,"discounted_cash":2062.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR IMRT SIMPLE BID","code_information":[{"code":"3337738502","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77385","type":"HCPCS"}],"standard_charges":[{"gross_charge":2062.18,"discounted_cash":2062.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR IMRT COMPLEX","code_information":[{"code":"3337738601","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":2062.18,"discounted_cash":2062.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR IMRT COMPLEX BID","code_information":[{"code":"3337738602","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77386","type":"HCPCS"}],"standard_charges":[{"gross_charge":2062.18,"discounted_cash":2062.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GUIDANCE FOR LOCLZJ TARGET VOL FOR RADJ TX DLVR","code_information":[{"code":"3337738701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77387","type":"HCPCS"}],"standard_charges":[{"gross_charge":487.55,"discounted_cash":487.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RADIATION TREATMENT DELIVERY SUPERFICIAL PER DAY","code_information":[{"code":"3337740101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77401","type":"HCPCS"}],"standard_charges":[{"gross_charge":404.64,"discounted_cash":404.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR DELIVERY >=1 MEV SIMPLE","code_information":[{"code":"3337740201","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77402","type":"HCPCS"}],"standard_charges":[{"gross_charge":733.95,"discounted_cash":733.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RAD TX DELIVERY INTERMEDIATE","code_information":[{"code":"3337740701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":940.0,"discounted_cash":940.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RAD TX DELIVERY INTERMEDIATE BID","code_information":[{"code":"3337740702","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77407","type":"HCPCS"}],"standard_charges":[{"gross_charge":680.44,"discounted_cash":680.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR DELIVERY >=1 MEV COMPLEX","code_information":[{"code":"3337741201","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":866.65,"discounted_cash":866.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR DELIVERY >=1 MEV COMPLEX BID","code_information":[{"code":"3337741202","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77412","type":"HCPCS"}],"standard_charges":[{"gross_charge":1240.38,"discounted_cash":1240.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR PORT FILM PER 5 FRACTIONS","code_information":[{"code":"3337741701","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.82,"discounted_cash":386.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TR THERAPEUTIC RADIOLOGY PORT IMAGES(S) ADDL","code_information":[{"code":"3337741702","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77417","type":"HCPCS"}],"standard_charges":[{"gross_charge":386.82,"discounted_cash":386.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPECIAL RADIATION TREATMENT","code_information":[{"code":"3337747001","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77470","type":"HCPCS"}],"standard_charges":[{"gross_charge":2821.36,"discounted_cash":2821.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRACHYTHERAPY INTRACAVITARY SIMPLE","code_information":[{"code":"3337776101","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77761","type":"HCPCS"}],"standard_charges":[{"gross_charge":1527.3,"discounted_cash":1527.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRACHYTHERAPY INTRACAVITARY INTERMEDIATE","code_information":[{"code":"3337776201","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77762","type":"HCPCS"}],"standard_charges":[{"gross_charge":1527.3,"discounted_cash":1527.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRACHYTHERAPY INTRACAVITARY COMPLEX","code_information":[{"code":"3337776301","type":"CDM"},{"code":"0333","type":"RC"},{"code":"77763","type":"HCPCS"}],"standard_charges":[{"gross_charge":1996.9,"discounted_cash":1996.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF, CHEMO, SGL/INITIAL DRUG, TO 1 HR","code_information":[{"code":"3359641301","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96413","type":"HCPCS"}],"standard_charges":[{"gross_charge":1133.38,"discounted_cash":1133.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF, CHEMO, SGL/INITIAL DRUG, EA ADDL HR","code_information":[{"code":"3359641501","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96415","type":"HCPCS"}],"standard_charges":[{"gross_charge":310.03,"discounted_cash":310.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IV INF, CHEMO, EA SEQUENTIAL, TO 1 HR","code_information":[{"code":"3359641701","type":"CDM"},{"code":"0335","type":"RC"},{"code":"96417","type":"HCPCS"}],"standard_charges":[{"gross_charge":311.52,"discounted_cash":311.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROID UPTAKE W/BLOOD FLOW SNGLE/MULT QUAN MEAS","code_information":[{"code":"3417801401","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78014","type":"HCPCS"}],"standard_charges":[{"gross_charge":2085.18,"discounted_cash":2085.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THYROID MET IMAGING BODY","code_information":[{"code":"3417801801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78018","type":"HCPCS"}],"standard_charges":[{"gross_charge":2572.88,"discounted_cash":2572.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARATHYROID PLANAR IMAGING","code_information":[{"code":"3417807001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78070","type":"HCPCS"}],"standard_charges":[{"gross_charge":1373.87,"discounted_cash":1373.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PARATHYROID PLANAR IMAGING W/WO SUBTRACTION","code_information":[{"code":"3417807101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78071","type":"HCPCS"}],"standard_charges":[{"gross_charge":2135.62,"discounted_cash":2135.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LYMPHATICS & LYMPH GLANDS IMAGING","code_information":[{"code":"3417819502","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78195","type":"HCPCS"}],"standard_charges":[{"gross_charge":3088.29,"discounted_cash":3088.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER","code_information":[{"code":"3417822601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78226","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.42,"discounted_cash":1413.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEPATOBIL SYST IMAG INC GB W/PHARMA INTERVENJ","code_information":[{"code":"3417822702","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78227","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.42,"discounted_cash":1413.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GASTRIC EMPTYING IMAGING STUDY","code_information":[{"code":"3417826401","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78264","type":"HCPCS"}],"standard_charges":[{"gross_charge":2949.56,"discounted_cash":2949.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ACUTE GI BLOOD LOSS IMAGING","code_information":[{"code":"3417827801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78278","type":"HCPCS"}],"standard_charges":[{"gross_charge":2788.1,"discounted_cash":2788.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BOWEL IMAGING","code_information":[{"code":"3417829001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78290","type":"HCPCS"}],"standard_charges":[{"gross_charge":2524.29,"discounted_cash":2524.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BONE IMAGING, LIMITED AREA","code_information":[{"code":"3417830001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78300","type":"HCPCS"}],"standard_charges":[{"gross_charge":2299.14,"discounted_cash":2299.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BONE IMAGING, WHOLE BODY","code_information":[{"code":"3417830601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78306","type":"HCPCS"}],"standard_charges":[{"gross_charge":4243.53,"discounted_cash":4243.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BONE IMAGING, 3 PHASE","code_information":[{"code":"3417831501","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78315","type":"HCPCS"}],"standard_charges":[{"gross_charge":5128.19,"discounted_cash":5128.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HT MUSCLE IMAGE SPECT SING - NM HEART PERFUSION SPECT STRESS","code_information":[{"code":"3417845108","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78451","type":"HCPCS"}],"standard_charges":[{"gross_charge":4661.98,"discounted_cash":4661.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYOCARDIAL SPECT MULTIPLE STUDIES","code_information":[{"code":"3417845201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78452","type":"HCPCS"}],"standard_charges":[{"gross_charge":9158.19,"discounted_cash":9158.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GATED HEART, PLANAR SINGLE","code_information":[{"code":"3417847201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78472","type":"HCPCS"}],"standard_charges":[{"gross_charge":2865.42,"discounted_cash":2865.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LUNG PERFUSION IMAGING","code_information":[{"code":"3417858001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78580","type":"HCPCS"}],"standard_charges":[{"gross_charge":4016.12,"discounted_cash":4016.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PULMONARY VENTILATION & PERFUSION IMAGING","code_information":[{"code":"3417858201","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78582","type":"HCPCS"}],"standard_charges":[{"gross_charge":1524.16,"discounted_cash":1524.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC QUANT DIFF PULM PRFUSION & VENTLAJ W/WO IMAGING","code_information":[{"code":"3417859801","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78598","type":"HCPCS"}],"standard_charges":[{"gross_charge":1524.16,"discounted_cash":1524.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRAIN IMAGING < 4 STATIC VIEWS W VASCULAR FLOW","code_information":[{"code":"3417860101","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78601","type":"HCPCS"}],"standard_charges":[{"gross_charge":2774.45,"discounted_cash":2774.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRAIN IMAGING MIN 4 STATIC VIEWS W VASCULAR FLOW","code_information":[{"code":"3417860601","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78606","type":"HCPCS"}],"standard_charges":[{"gross_charge":3624.97,"discounted_cash":3624.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RENAL FLOW/FUNCT IMAGE,PHARM RX","code_information":[{"code":"3417870803","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78708","type":"HCPCS"}],"standard_charges":[{"gross_charge":3488.52,"discounted_cash":3488.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RP LOCLZJ TUM PLNR 1 AREA SINGLE DAY IMAGING","code_information":[{"code":"3417880001","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78800","type":"HCPCS"}],"standard_charges":[{"gross_charge":3131.48,"discounted_cash":3131.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RP LOCLZJ TUM PLNR WHOLE BODY SINGLE DAY IMAGING","code_information":[{"code":"3417880203","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78802","type":"HCPCS"}],"standard_charges":[{"gross_charge":3754.6,"discounted_cash":3754.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RP LOCLZJ TUM SPECT 1 AREA SINGLE DAY IMAGING","code_information":[{"code":"3417880301","type":"CDM"},{"code":"0341","type":"RC"},{"code":"78803","type":"HCPCS"}],"standard_charges":[{"gross_charge":3746.44,"discounted_cash":3746.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NUCLEAR THERAPY, ORAL","code_information":[{"code":"3427900503","type":"CDM"},{"code":"0342","type":"RC"},{"code":"79005","type":"HCPCS"}],"standard_charges":[{"gross_charge":617.57,"discounted_cash":617.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CERBRAL PERFUSION STUDY, CT W/ CONTRAST","code_information":[{"code":"3500042T01","type":"CDM"},{"code":"0350","type":"RC"},{"code":"0042T","type":"HCPCS"}],"standard_charges":[{"gross_charge":3758.1,"discounted_cash":3758.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT 3D RENDERING W/INTERP&POSTPROC DIFF WORK STATION","code_information":[{"code":"3507637701","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76377","type":"HCPCS"}],"standard_charges":[{"gross_charge":939.84,"discounted_cash":939.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,LIMITED/LOCALIZED F/U STUDY","code_information":[{"code":"3507638001","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76380","type":"HCPCS"}],"standard_charges":[{"gross_charge":1437.73,"discounted_cash":1437.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT WHOLE BODY LOW DOSE MYELOMA W/O CONTRAST","code_information":[{"code":"3507649702","type":"CDM"},{"code":"0350","type":"RC"},{"code":"76497","type":"HCPCS"}],"standard_charges":[{"gross_charge":5419.4,"discounted_cash":5419.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT GUIDANCE NEEDLE PLACEMENT","code_information":[{"code":"3507701243","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77012","type":"HCPCS"}],"standard_charges":[{"gross_charge":3887.4,"discounted_cash":3887.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT GUIDANCE TISSUE ABLATION","code_information":[{"code":"3507701310","type":"CDM"},{"code":"0350","type":"RC"},{"code":"77013","type":"HCPCS"}],"standard_charges":[{"gross_charge":1380.38,"discounted_cash":1380.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,HEAD/BRAIN,W/O CONTRAST MATL","code_information":[{"code":"3517045001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70450","type":"HCPCS"}],"standard_charges":[{"gross_charge":4076.47,"discounted_cash":4076.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN HEAD CONTRAST","code_information":[{"code":"3517046001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70460","type":"HCPCS"}],"standard_charges":[{"gross_charge":4281.87,"discounted_cash":4281.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN HEAD COMBO","code_information":[{"code":"3517047001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70470","type":"HCPCS"}],"standard_charges":[{"gross_charge":4802.62,"discounted_cash":4802.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,ORBIT/SELLA/POST FOSSA/EAR,W/O","code_information":[{"code":"3517048001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70480","type":"HCPCS"}],"standard_charges":[{"gross_charge":3799.77,"discounted_cash":3799.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN ORBIT/SELLA/POST FOSSA/EAR CONTRAST","code_information":[{"code":"3517048101","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70481","type":"HCPCS"}],"standard_charges":[{"gross_charge":4170.0,"discounted_cash":4170.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,MAXILLOFACIAL AREA,W/O CONTRAST","code_information":[{"code":"3517048602","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70486","type":"HCPCS"}],"standard_charges":[{"gross_charge":2154.14,"discounted_cash":2154.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN, FACE/JAW CONTRAST","code_information":[{"code":"3517048702","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70487","type":"HCPCS"}],"standard_charges":[{"gross_charge":2845.76,"discounted_cash":2845.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,SOFT TISSUE NECK,W/O CONTRAST","code_information":[{"code":"3517049001","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70490","type":"HCPCS"}],"standard_charges":[{"gross_charge":3277.02,"discounted_cash":3277.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT NECK TISSUE CONTRAST","code_information":[{"code":"3517049101","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70491","type":"HCPCS"}],"standard_charges":[{"gross_charge":3618.76,"discounted_cash":3618.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT NECK TISSUE COMBO","code_information":[{"code":"3517049201","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70492","type":"HCPCS"}],"standard_charges":[{"gross_charge":3946.26,"discounted_cash":3946.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO,HEAD COMBO,INCL IMAGE PROCESS","code_information":[{"code":"3517049602","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70496","type":"HCPCS"}],"standard_charges":[{"gross_charge":6401.42,"discounted_cash":6401.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO,NECK COMBO,INCL IMAGE PROCESS","code_information":[{"code":"3517049802","type":"CDM"},{"code":"0351","type":"RC"},{"code":"70498","type":"HCPCS"}],"standard_charges":[{"gross_charge":5534.91,"discounted_cash":5534.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,THORAX,W/O CONTRAST","code_information":[{"code":"3527125001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71250","type":"HCPCS"}],"standard_charges":[{"gross_charge":4544.88,"discounted_cash":4544.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CAT SCAN OF CHEST CONTRAST","code_information":[{"code":"3527126002","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71260","type":"HCPCS"}],"standard_charges":[{"gross_charge":5049.64,"discounted_cash":5049.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CAT SCAN OF CHEST COMBO","code_information":[{"code":"3527127001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71270","type":"HCPCS"}],"standard_charges":[{"gross_charge":5474.19,"discounted_cash":5474.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LDCT FOR LUNG CA SCREEN","code_information":[{"code":"3527127101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71271","type":"HCPCS"}],"standard_charges":[{"gross_charge":2211.69,"discounted_cash":2211.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO, CHEST, COMBO, INCL IMAGE PROC","code_information":[{"code":"3527127501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"71275","type":"HCPCS"}],"standard_charges":[{"gross_charge":5247.52,"discounted_cash":5247.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,CERVICAL SPINE,W/O CONTRAST","code_information":[{"code":"3527212501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72125","type":"HCPCS"}],"standard_charges":[{"gross_charge":3621.98,"discounted_cash":3621.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN CERV SPINE CONTRAST","code_information":[{"code":"3527212601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72126","type":"HCPCS"}],"standard_charges":[{"gross_charge":3685.36,"discounted_cash":3685.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,THORACIC SPINE,W/O CONTRAST","code_information":[{"code":"3527212801","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72128","type":"HCPCS"}],"standard_charges":[{"gross_charge":3907.08,"discounted_cash":3907.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN DORSAL SP CONTRAST","code_information":[{"code":"3527212901","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72129","type":"HCPCS"}],"standard_charges":[{"gross_charge":4280.91,"discounted_cash":4280.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,LUMBAR SPINE,W/O CONTRAST","code_information":[{"code":"3527213101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72131","type":"HCPCS"}],"standard_charges":[{"gross_charge":3328.43,"discounted_cash":3328.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN LUMBAR SP CONTRAST","code_information":[{"code":"3527213201","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72132","type":"HCPCS"}],"standard_charges":[{"gross_charge":3733.93,"discounted_cash":3733.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,PELVIS,W/O CONTRAST","code_information":[{"code":"3527219201","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72192","type":"HCPCS"}],"standard_charges":[{"gross_charge":5022.2,"discounted_cash":5022.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN OF PELVIS CONTRAST","code_information":[{"code":"3527219301","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72193","type":"HCPCS"}],"standard_charges":[{"gross_charge":5719.12,"discounted_cash":5719.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN OF PELVIS COMBO","code_information":[{"code":"3527219401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"72194","type":"HCPCS"}],"standard_charges":[{"gross_charge":5647.19,"discounted_cash":5647.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,UPPER EXTREMITY,W/O CONTRAST","code_information":[{"code":"3527320010","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3609.3,"discounted_cash":3609.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN OF ARM CONTRAST","code_information":[{"code":"3527320112","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73201","type":"HCPCS"}],"standard_charges":[{"gross_charge":4008.47,"discounted_cash":4008.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO,UPPER EXTREM,COMBO","code_information":[{"code":"3527320601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73206","type":"HCPCS"}],"standard_charges":[{"gross_charge":5807.84,"discounted_cash":5807.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,LOWER EXTREMITY,W/O CONTRAST - LOWER EXTREMITY WO IV CONTRAST","code_information":[{"code":"3527370013","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73700","type":"HCPCS"}],"standard_charges":[{"gross_charge":3984.31,"discounted_cash":3984.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN OF LEG CONTRAST","code_information":[{"code":"3527370107","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73701","type":"HCPCS"}],"standard_charges":[{"gross_charge":4008.47,"discounted_cash":4008.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO,LOWER EXTREM,COMBO,IMAGE PRC","code_information":[{"code":"3527370601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"73706","type":"HCPCS"}],"standard_charges":[{"gross_charge":5011.62,"discounted_cash":5011.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,ABDOMEN,W/O CONTRAST","code_information":[{"code":"3527415001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74150","type":"HCPCS"}],"standard_charges":[{"gross_charge":4656.86,"discounted_cash":4656.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN OF ABDOMEN CONTRAST","code_information":[{"code":"3527416001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74160","type":"HCPCS"}],"standard_charges":[{"gross_charge":6192.24,"discounted_cash":6192.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN OF ABDOMEN W/WO CONT","code_information":[{"code":"3527417001","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74170","type":"HCPCS"}],"standard_charges":[{"gross_charge":7083.46,"discounted_cash":7083.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO ABD&PLVIS CNTRST MTRL W/WO CNTRST IMGES","code_information":[{"code":"3527417401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74174","type":"HCPCS"}],"standard_charges":[{"gross_charge":8576.59,"discounted_cash":8576.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO, ABD, COMBO,INCL IMAGE PROC","code_information":[{"code":"3527417501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74175","type":"HCPCS"}],"standard_charges":[{"gross_charge":8576.59,"discounted_cash":8576.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,W/O CONTRAST","code_information":[{"code":"3527417601","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74176","type":"HCPCS"}],"standard_charges":[{"gross_charge":9679.06,"discounted_cash":9679.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,W CONTRAST","code_information":[{"code":"3527417701","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74177","type":"HCPCS"}],"standard_charges":[{"gross_charge":11911.36,"discounted_cash":11911.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT SCAN,ABDOMEN AND PELVIS,COMBO","code_information":[{"code":"3527417801","type":"CDM"},{"code":"0352","type":"RC"},{"code":"74178","type":"HCPCS"}],"standard_charges":[{"gross_charge":13309.46,"discounted_cash":13309.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT HEART W/O CONTRAST QUANT EVAL CORONARY CALCIUM","code_information":[{"code":"3527557101","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75571","type":"HCPCS"}],"standard_charges":[{"gross_charge":115.76,"discounted_cash":115.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO HRT CORNRY ART/BYPASS GRFTS CONTRST 3D POST","code_information":[{"code":"3527557401","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75574","type":"HCPCS"}],"standard_charges":[{"gross_charge":1395.8,"discounted_cash":1395.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CT ANGIO AORTOBIFEMORAL, COMBO","code_information":[{"code":"3527563501","type":"CDM"},{"code":"0352","type":"RC"},{"code":"75635","type":"HCPCS"}],"standard_charges":[{"gross_charge":9814.2,"discounted_cash":9814.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000020","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7467.23,"discounted_cash":7467.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000021","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":63.26,"discounted_cash":63.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000022","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8580.76,"discounted_cash":8580.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000023","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":81.34,"discounted_cash":81.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000024","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9406.53,"discounted_cash":9406.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000025","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":99.81,"discounted_cash":99.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000026","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11215.73,"discounted_cash":11215.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000027","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":117.5,"discounted_cash":117.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000028","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":12779.08,"discounted_cash":12779.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR CARD - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000029","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":125.54,"discounted_cash":125.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000030","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":5848.76,"discounted_cash":5848.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000031","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":52.25,"discounted_cash":52.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000032","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7146.41,"discounted_cash":7146.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000033","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":66.33,"discounted_cash":66.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000034","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8290.8,"discounted_cash":8290.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000035","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":81.44,"discounted_cash":81.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000036","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8728.49,"discounted_cash":8728.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000037","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":69.58,"discounted_cash":69.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000038","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9566.39,"discounted_cash":9566.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENT - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000039","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":69.58,"discounted_cash":69.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000040","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7083.56,"discounted_cash":7083.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000041","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":63.26,"discounted_cash":63.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000042","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8553.2,"discounted_cash":8553.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000043","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":82.62,"discounted_cash":82.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000044","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9498.04,"discounted_cash":9498.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000045","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":101.0,"discounted_cash":101.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000046","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10832.06,"discounted_cash":10832.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000047","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":114.53,"discounted_cash":114.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000048","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11669.96,"discounted_cash":11669.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GENERAL - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000049","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":122.68,"discounted_cash":122.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000050","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7021.82,"discounted_cash":7021.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000051","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":63.26,"discounted_cash":63.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000052","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8482.64,"discounted_cash":8482.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000053","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":77.51,"discounted_cash":77.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000054","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9776.97,"discounted_cash":9776.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000055","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":101.78,"discounted_cash":101.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000056","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10403.19,"discounted_cash":10403.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000057","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":113.91,"discounted_cash":113.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000058","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":12848.54,"discounted_cash":12848.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR GYN - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000059","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":126.22,"discounted_cash":126.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000060","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8391.13,"discounted_cash":8391.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000061","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":63.27,"discounted_cash":63.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000062","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10179.38,"discounted_cash":10179.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000063","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":60.44,"discounted_cash":60.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000064","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11965.43,"discounted_cash":11965.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000065","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":69.59,"discounted_cash":69.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000066","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":12748.21,"discounted_cash":12748.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000067","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":66.64,"discounted_cash":66.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000068","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":13530.98,"discounted_cash":13530.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR NEURO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000069","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":69.59,"discounted_cash":69.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000070","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6288.66,"discounted_cash":6288.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000071","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":63.27,"discounted_cash":63.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000072","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7431.95,"discounted_cash":7431.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000073","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":63.27,"discounted_cash":63.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000074","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8910.41,"discounted_cash":8910.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000075","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":69.58,"discounted_cash":69.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000076","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9936.83,"discounted_cash":9936.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000077","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":69.59,"discounted_cash":69.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000078","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10931.29,"discounted_cash":10931.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OPTH - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000079","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":69.59,"discounted_cash":69.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000080","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8007.46,"discounted_cash":8007.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000081","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":63.26,"discounted_cash":63.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000082","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9484.81,"discounted_cash":9484.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000083","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":86.26,"discounted_cash":86.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000084","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10701.97,"discounted_cash":10701.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000085","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":116.28,"discounted_cash":116.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000086","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11920.23,"discounted_cash":11920.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000087","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":128.69,"discounted_cash":128.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000088","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":14271.86,"discounted_cash":14271.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ORTHO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000089","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":147.98,"discounted_cash":147.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"3600000090","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8007.46,"discounted_cash":8007.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"3600000091","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":57.52,"discounted_cash":57.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"3600000092","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":9484.81,"discounted_cash":9484.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"3600000093","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":78.42,"discounted_cash":78.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"3600000094","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":10701.97,"discounted_cash":10701.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"3600000095","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":105.68,"discounted_cash":105.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"3600000096","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":11920.23,"discounted_cash":11920.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"3600000097","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":116.99,"discounted_cash":116.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"3600000098","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":14271.86,"discounted_cash":14271.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ROBOT - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"3600000099","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":134.53,"discounted_cash":134.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"36000000A1","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":5137.65,"discounted_cash":5137.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"36000000A2","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":47.41,"discounted_cash":47.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"36000000A3","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":5889.56,"discounted_cash":5889.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"36000000A4","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":54.06,"discounted_cash":54.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"36000000A5","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6667.92,"discounted_cash":6667.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"36000000A6","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":70.64,"discounted_cash":70.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"36000000A7","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":7640.33,"discounted_cash":7640.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"36000000A8","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":80.3,"discounted_cash":80.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"36000000A9","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":8305.13,"discounted_cash":8305.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR UROL - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"36000000B1","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":81.59,"discounted_cash":81.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 1 FIRST 30 MINUTES","code_information":[{"code":"36000000C3","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":3707.71,"discounted_cash":3707.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"36000000C4","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 2 FIRST 30 MINUTES","code_information":[{"code":"36000000C5","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":6137.78,"discounted_cash":6137.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"36000000C6","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 3 FIRST 30 MINUTES","code_information":[{"code":"36000000C7","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":16192.91,"discounted_cash":16192.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"36000000C8","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 4 FIRST 30 MINUTES","code_information":[{"code":"36000000C9","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":17087.65,"discounted_cash":17087.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"36000000D1","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 5 FIRST 30 MINUTES","code_information":[{"code":"36000000D2","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":18248.7,"discounted_cash":18248.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR OB - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"36000000D3","type":"CDM"},{"code":"0360","type":"RC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRANSCATH INS DUAL-CHAMB LEADLESS PACEMKR RT ATRIAL COMP","code_information":[{"code":"3600796T01","type":"CDM"},{"code":"0360","type":"RC"},{"code":"0796T","type":"HCPCS"}],"standard_charges":[{"gross_charge":17355.49,"discounted_cash":17355.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MINOR SURGICAL PROCEDURE OTHER","code_information":[{"code":"3610000001","type":"CDM"},{"code":"0361","type":"RC"}],"standard_charges":[{"gross_charge":1269.5,"discounted_cash":1269.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ SAC AGMNTJ UNI W/WO BALO/MCHNL DEV 1/> NDL","code_information":[{"code":"3610200T01","type":"CDM"},{"code":"0361","type":"RC"},{"code":"0200T","type":"HCPCS"}],"standard_charges":[{"gross_charge":9315.48,"discounted_cash":9315.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION","code_information":[{"code":"3611000501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2277.72,"discounted_cash":2277.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL","code_information":[{"code":"3611000601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1138.87,"discounted_cash":1138.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMAGE-GUIDED CATHETER FLUID COLLECTION DRAINAGE","code_information":[{"code":"3611003001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10030","type":"HCPCS"}],"standard_charges":[{"gross_charge":2617.39,"discounted_cash":2617.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN SKIN ABSCESS SIMPLE","code_information":[{"code":"3611006001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10060","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.19,"discounted_cash":759.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN SKIN ABSCESS COMPLIC","code_information":[{"code":"3611006101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10061","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.46,"discounted_cash":1999.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN PILONIDAL CYST SIMPL","code_information":[{"code":"3611008001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10080","type":"HCPCS"}],"standard_charges":[{"gross_charge":2102.05,"discounted_cash":2102.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN PILONIDAL CYST COMPLIC","code_information":[{"code":"3611008101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10081","type":"HCPCS"}],"standard_charges":[{"gross_charge":2102.05,"discounted_cash":2102.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVE FOREIGN BODY SIMPLE","code_information":[{"code":"3611012001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10120","type":"HCPCS"}],"standard_charges":[{"gross_charge":1654.33,"discounted_cash":1654.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVE FOREIGN BODY COMPLIC","code_information":[{"code":"3611012101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10121","type":"HCPCS"}],"standard_charges":[{"gross_charge":5641.49,"discounted_cash":5641.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAINAGE OF HEMATOMA/FLUID","code_information":[{"code":"3611014001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10140","type":"HCPCS"}],"standard_charges":[{"gross_charge":4752.85,"discounted_cash":4752.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PUNCTURE DRAINAGE OF LESION","code_information":[{"code":"3611016001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"10160","type":"HCPCS"}],"standard_charges":[{"gross_charge":525.99,"discounted_cash":525.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DEBRIDEMENT, SKIN, SUB-Q TISSUE,=<20 SQ CM","code_information":[{"code":"3611104201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11042","type":"HCPCS"}],"standard_charges":[{"gross_charge":362.92,"discounted_cash":362.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRIM NAIL(S)","code_information":[{"code":"3611171901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11719","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.03,"discounted_cash":188.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL OF NAIL PLATE","code_information":[{"code":"3611173001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11730","type":"HCPCS"}],"standard_charges":[{"gross_charge":584.19,"discounted_cash":584.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN BLOOD FROM UNDER NAIL","code_information":[{"code":"3611174001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11740","type":"HCPCS"}],"standard_charges":[{"gross_charge":110.09,"discounted_cash":110.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RECONSTRUC OF NAIL BED","code_information":[{"code":"3611176001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11760","type":"HCPCS"}],"standard_charges":[{"gross_charge":850.88,"discounted_cash":850.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EXCISION OF NAIL FOLD, TOE","code_information":[{"code":"3611176501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"11765","type":"HCPCS"}],"standard_charges":[{"gross_charge":880.99,"discounted_cash":880.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND BODY <2.5CM","code_information":[{"code":"3611200101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12001","type":"HCPCS"}],"standard_charges":[{"gross_charge":416.27,"discounted_cash":416.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUP NPTERF WND BODY 2.6-7.5 CM","code_information":[{"code":"3611200201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12002","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.6,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND BODY 7.6-12.5 CM","code_information":[{"code":"3611200401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12004","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.6,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND BODY 12.6-20 CM","code_information":[{"code":"3611200501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12005","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.55,"discounted_cash":1167.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND BODY 20.1-30 CM","code_information":[{"code":"3611200601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12006","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.55,"discounted_cash":1167.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND BODY >30 CM","code_information":[{"code":"3611200701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12007","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.6,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND FACE <2.5 CM","code_information":[{"code":"3611201101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12011","type":"HCPCS"}],"standard_charges":[{"gross_charge":415.54,"discounted_cash":415.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND FACE 2.6-5 CM","code_information":[{"code":"3611201301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12013","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.6,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND FACE 5.1-7.5 CM","code_information":[{"code":"3611201401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12014","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.6,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND FACE 7.6-12.5 CM","code_information":[{"code":"3611201501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12015","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.6,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RESUPERF WND FACE 12.6-20 CM","code_information":[{"code":"3611201601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12016","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.55,"discounted_cash":1167.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG <2.5 CM","code_information":[{"code":"3611203101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12031","type":"HCPCS"}],"standard_charges":[{"gross_charge":8255.73,"discounted_cash":8255.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM","code_information":[{"code":"3611203201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":1094.78,"discounted_cash":1094.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 2.6-7.5 CM","code_information":[{"code":"36112032PB","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12032","type":"HCPCS"}],"standard_charges":[{"gross_charge":838.73,"discounted_cash":838.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 7.6-12.5 CM","code_information":[{"code":"3611203401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12034","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.59,"discounted_cash":618.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 12.6-20 CM","code_information":[{"code":"3611203501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1167.55,"discounted_cash":1167.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND TRUNK,ARM,LEG 20.1-30 CM","code_information":[{"code":"3611203601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12036","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.15,"discounted_cash":1769.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND REST BODY <2.5 CM","code_information":[{"code":"3611204101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12041","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.59,"discounted_cash":618.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND REST BODY 2.6-7.5 CM","code_information":[{"code":"3611204201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12042","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.59,"discounted_cash":618.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND REST BODY 7.6-12.5 CM","code_information":[{"code":"3611204401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12044","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.15,"discounted_cash":1769.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL <2.5 CM","code_information":[{"code":"3611205101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12051","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.59,"discounted_cash":618.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 2.5-5 CM","code_information":[{"code":"3611205201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12052","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.59,"discounted_cash":618.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 5.1-7.5 CM","code_information":[{"code":"3611205301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12053","type":"HCPCS"}],"standard_charges":[{"gross_charge":618.59,"discounted_cash":618.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LAYR CLOS WND FACE,FACIAL 7.6-12.5 CM","code_information":[{"code":"3611205401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"12054","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.99,"discounted_cash":649.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REP COMPL TRUNK 2.6-7.5 CM","code_information":[{"code":"3611310101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13101","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.15,"discounted_cash":1769.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REP COMPL TRUNK EACH ADDL 5 OR LESS CM","code_information":[{"code":"3611310201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13102","type":"HCPCS"}],"standard_charges":[{"gross_charge":1769.15,"discounted_cash":1769.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RECMPL WND SCALP,EXTR 2.6-7.5 CM","code_information":[{"code":"3611312101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13121","type":"HCPCS"}],"standard_charges":[{"gross_charge":2302.5,"discounted_cash":2302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REP,SKIN,SCALP/EXTREM+5 CM/<","code_information":[{"code":"3611312201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13122","type":"HCPCS"}],"standard_charges":[{"gross_charge":2302.5,"discounted_cash":2302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RECMPL WND HEAD,FAC,HAND 1.1-2.5 CM","code_information":[{"code":"3611313101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13131","type":"HCPCS"}],"standard_charges":[{"gross_charge":2302.5,"discounted_cash":2302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RECMPL WND HEAD,FAC,HAND 2.6-7.5 CM","code_information":[{"code":"3611313201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"13132","type":"HCPCS"}],"standard_charges":[{"gross_charge":2302.5,"discounted_cash":2302.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INITIAL RX BURN(S) 1ST DEGREE","code_information":[{"code":"3611600001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16000","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.86,"discounted_cash":499.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRESS/DEBRID SMALL BURN NO ANES","code_information":[{"code":"3611602001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16020","type":"HCPCS"}],"standard_charges":[{"gross_charge":462.35,"discounted_cash":462.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRESS/DEBRID MED BURN NO ANESTH","code_information":[{"code":"3611602501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"16025","type":"HCPCS"}],"standard_charges":[{"gross_charge":567.25,"discounted_cash":567.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHEM CAUTERY GRANULATN TISSUE","code_information":[{"code":"3611725001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"17250","type":"HCPCS"}],"standard_charges":[{"gross_charge":531.12,"discounted_cash":531.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PUNC/ASPIR BREAST CYST","code_information":[{"code":"3611900001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19000","type":"HCPCS"}],"standard_charges":[{"gross_charge":2486.52,"discounted_cash":2486.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION STEREOTACTIC GUIDE","code_information":[{"code":"3611908101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19081","type":"HCPCS"}],"standard_charges":[{"gross_charge":4253.13,"discounted_cash":4253.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BX BREAST W DEVICE ADDL LESION STEREOTACT GUIDE","code_information":[{"code":"3611908201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19082","type":"HCPCS"}],"standard_charges":[{"gross_charge":3146.52,"discounted_cash":3146.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION ULTRASOUND GUIDE","code_information":[{"code":"3611908301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19083","type":"HCPCS"}],"standard_charges":[{"gross_charge":3900.0,"discounted_cash":3900.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BX BREAST W DEVICE ADDL LESION ULTRASOUND GUIDE","code_information":[{"code":"3611908401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19084","type":"HCPCS"}],"standard_charges":[{"gross_charge":1692.64,"discounted_cash":1692.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BX BREAST W DEVICE 1ST LESION MAGNETIC RES GUIDE","code_information":[{"code":"3611908501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19085","type":"HCPCS"}],"standard_charges":[{"gross_charge":3146.52,"discounted_cash":3146.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BX BREAST W DEVICE ADDL LESION MAGNET RES GUIDE","code_information":[{"code":"3611908601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19086","type":"HCPCS"}],"standard_charges":[{"gross_charge":3146.52,"discounted_cash":3146.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ DEVICE PLACEMT BREAST LOC 1ST LES W GUIDNCE","code_information":[{"code":"3611928101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19281","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.58,"discounted_cash":2112.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ BREAST LOC DEVICE PLACEMT 1ST LESIO US IMAG","code_information":[{"code":"3611928501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19285","type":"HCPCS"}],"standard_charges":[{"gross_charge":2112.58,"discounted_cash":2112.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ BREAST LOC DEVICE PLACEMT EACH LES US IMAGE","code_information":[{"code":"3611928601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"19286","type":"HCPCS"}],"standard_charges":[{"gross_charge":1267.55,"discounted_cash":1267.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEEDLE BIOPSY,MUSCLE","code_information":[{"code":"3612020601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20206","type":"HCPCS"}],"standard_charges":[{"gross_charge":2331.72,"discounted_cash":2331.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BONE BIOPSY,TROCAR/NEEDLE SUPERF","code_information":[{"code":"3612022001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20220","type":"HCPCS"}],"standard_charges":[{"gross_charge":3500.07,"discounted_cash":3500.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BONE BIOPSY,TROCAR/NEEDLE DEEP","code_information":[{"code":"3612022501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20225","type":"HCPCS"}],"standard_charges":[{"gross_charge":1706.47,"discounted_cash":1706.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECT SINUS TRACT FOR DX W XRAY","code_information":[{"code":"3612050101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20501","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.87,"discounted_cash":418.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL OF FOREIGN BODY","code_information":[{"code":"3612052001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20520","type":"HCPCS"}],"standard_charges":[{"gross_charge":4752.85,"discounted_cash":4752.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRY NEEDLING 3 OR MORE MUSCLES","code_information":[{"code":"3612056101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20561","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.44,"discounted_cash":83.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US","code_information":[{"code":"3612060501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20605","type":"HCPCS"}],"standard_charges":[{"gross_charge":882.54,"discounted_cash":882.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US","code_information":[{"code":"3612061001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20610","type":"HCPCS"}],"standard_charges":[{"gross_charge":427.38,"discounted_cash":427.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/US","code_information":[{"code":"3612061101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"20611","type":"HCPCS"}],"standard_charges":[{"gross_charge":406.14,"discounted_cash":406.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REDUCE TEMPOROMANDIBL DISLOC,COMP","code_information":[{"code":"3612148501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"21485","type":"HCPCS"}],"standard_charges":[{"gross_charge":4569.44,"discounted_cash":4569.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BIOPSY SOFT TISSUE NECK/CHEST","code_information":[{"code":"3612155001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"21550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3396.27,"discounted_cash":3396.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULATION","code_information":[{"code":"3612251301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22513","type":"HCPCS"}],"standard_charges":[{"gross_charge":20156.62,"discounted_cash":20156.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ LMBR","code_information":[{"code":"3612251401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22514","type":"HCPCS"}],"standard_charges":[{"gross_charge":22233.31,"discounted_cash":22233.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ VERT AGMNTJ CAVITY CRTJ UNI/BI CANNULJ EACH","code_information":[{"code":"3612251501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"22515","type":"HCPCS"}],"standard_charges":[{"gross_charge":16181.34,"discounted_cash":16181.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVE FB SUBQ SHOULDER","code_information":[{"code":"3612333001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23330","type":"HCPCS"}],"standard_charges":[{"gross_charge":2102.05,"discounted_cash":2102.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ PROC SHOULDER ARTHROGRAPHY/CT/MRI","code_information":[{"code":"3612335001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23350","type":"HCPCS"}],"standard_charges":[{"gross_charge":428.16,"discounted_cash":428.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX SHLDR DISLOCATION","code_information":[{"code":"3612365001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23650","type":"HCPCS"}],"standard_charges":[{"gross_charge":3520.92,"discounted_cash":3520.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX SHLDR DISLOC,ANESTHESIA","code_information":[{"code":"3612365501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23655","type":"HCPCS"}],"standard_charges":[{"gross_charge":3974.34,"discounted_cash":3974.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX SHLDR DISLOC,GR TUB FX","code_information":[{"code":"3612366501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23665","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INCIS/DRAIN ARM/ELBOW INFECT BURSA","code_information":[{"code":"3612393101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"23931","type":"HCPCS"}],"standard_charges":[{"gross_charge":4752.85,"discounted_cash":4752.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVE FB UPPER ARM/ELBOW SUBQ","code_information":[{"code":"3612420001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24200","type":"HCPCS"}],"standard_charges":[{"gross_charge":4752.85,"discounted_cash":4752.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX MID HUMERUS FX,MANIPULATN","code_information":[{"code":"3612450501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24505","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX ELBOW DISLOCATION","code_information":[{"code":"3612460001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24600","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.03,"discounted_cash":1762.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX ELBOW DISLOCATN,ANESTHESIA","code_information":[{"code":"3612460501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24605","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX RADIAL HEAD DISLOC,CHILD","code_information":[{"code":"3612464001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"24640","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.03,"discounted_cash":1762.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX RADIAL SHAFT FX,MANIPULATN","code_information":[{"code":"3612550501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25505","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX RAD/ULNA SHAFT FX,MANIP","code_information":[{"code":"3612556501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25565","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX DIST RAD/ULNA FX","code_information":[{"code":"3612560001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.23,"discounted_cash":696.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX DIST RAD/ULNA FX","code_information":[{"code":"36125600PB","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25600","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.23,"discounted_cash":696.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX DIST RAD/ULNA FX,MANIPUL","code_information":[{"code":"3612560501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25605","type":"HCPCS"}],"standard_charges":[{"gross_charge":1566.51,"discounted_cash":1566.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED TREAT WRIST DISLOCATION","code_information":[{"code":"3612566001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25660","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.23,"discounted_cash":696.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX RADIO-ULNA DISLOCATION","code_information":[{"code":"3612567501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"25675","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.03,"discounted_cash":1762.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN FINGER ABSCESS,SIMPLE","code_information":[{"code":"3612601001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26010","type":"HCPCS"}],"standard_charges":[{"gross_charge":606.6,"discounted_cash":606.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN FINGER ABSCESS,COMPLICATED","code_information":[{"code":"3612601101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26011","type":"HCPCS"}],"standard_charges":[{"gross_charge":1402.85,"discounted_cash":1402.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX METACARPAL FX","code_information":[{"code":"3612660001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26600","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.16,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX METACARPAL FX,MANIP","code_information":[{"code":"3612660501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26605","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.16,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX, CARPOMETACAR DISLOC,NON-THUMB","code_information":[{"code":"3612667001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26670","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.23,"discounted_cash":696.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX MC-P DISLOC","code_information":[{"code":"3612670001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26700","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.5,"discounted_cash":943.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSE RX PROX/MID FING SHFT FX,MANIP","code_information":[{"code":"3612672501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26725","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.16,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA","code_information":[{"code":"3612673501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26735","type":"HCPCS"}],"standard_charges":[{"gross_charge":7837.18,"discounted_cash":7837.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSE RX FINGR ARTICULAR FX,MANIP","code_information":[{"code":"3612674201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26742","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX IP JT DISLOCATION","code_information":[{"code":"3612677001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"26770","type":"HCPCS"}],"standard_charges":[{"gross_charge":943.5,"discounted_cash":943.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECTION HIP ARTHROGRAM","code_information":[{"code":"3612709301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27093","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.87,"discounted_cash":418.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX TRAUMATIC HIP DISLOCATN","code_information":[{"code":"3612725001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27250","type":"HCPCS"}],"standard_charges":[{"gross_charge":3520.92,"discounted_cash":3520.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX POST HIP ARTHRPLAS DISLOC","code_information":[{"code":"3612726501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27265","type":"HCPCS"}],"standard_charges":[{"gross_charge":3520.92,"discounted_cash":3520.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX FEMUR SHAFT FX+MANIP","code_information":[{"code":"3612750201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27502","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX DIST FEM EPIPHYSIS+MANIP","code_information":[{"code":"3612751701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27517","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX KNEE DISLOCATN","code_information":[{"code":"3612755001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3520.92,"discounted_cash":3520.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX KNEECAP DISLOCATN","code_information":[{"code":"3612756001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27560","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.03,"discounted_cash":1762.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX TIBIA SHAFT FX","code_information":[{"code":"3612775001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27750","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.23,"discounted_cash":696.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX TIBIA SHAFT FX,MANIPULATN","code_information":[{"code":"3612775201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27752","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX POST MALLEOL FX W/ MANIP","code_information":[{"code":"3612776801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27768","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX DIST FIBULA FX,MANIP","code_information":[{"code":"3612778801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27788","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.23,"discounted_cash":696.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED TX BIMALLEOLAR ANKLE FRACTURE W MANIP","code_information":[{"code":"3612781001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27810","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX TRIMALLEOLAR FX,MANIP","code_information":[{"code":"3612781801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27818","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX ANKLE DISLOCATN","code_information":[{"code":"3612784001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27840","type":"HCPCS"}],"standard_charges":[{"gross_charge":1762.03,"discounted_cash":1762.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX ANKLE DISLOCATN,ANESTH","code_information":[{"code":"3612784201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"27842","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMV FOOT FOREIGN BODY,SUBCUTANEOUS","code_information":[{"code":"3612819001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28190","type":"HCPCS"}],"standard_charges":[{"gross_charge":3385.25,"discounted_cash":3385.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX TALUS FX,MANIP","code_information":[{"code":"3612843501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28435","type":"HCPCS"}],"standard_charges":[{"gross_charge":4704.96,"discounted_cash":4704.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX METATARSAL FX,MANIP","code_information":[{"code":"3612847501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28475","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.16,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX TOE FX,MANIPULATN","code_information":[{"code":"3612851501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28515","type":"HCPCS"}],"standard_charges":[{"gross_charge":734.16,"discounted_cash":734.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX TALOTARSAL DISLOC","code_information":[{"code":"3612857001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28570","type":"HCPCS"}],"standard_charges":[{"gross_charge":696.23,"discounted_cash":696.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX MT-PHAL TOE DISLOC,ANESTH","code_information":[{"code":"3612863501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28635","type":"HCPCS"}],"standard_charges":[{"gross_charge":4940.2,"discounted_cash":4940.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CLOSED RX I-P JT,TOE DISLOC,ANESTH","code_information":[{"code":"3612866501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"28665","type":"HCPCS"}],"standard_charges":[{"gross_charge":814.91,"discounted_cash":814.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY LONG ARM CAST","code_information":[{"code":"3612906501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29065","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.77,"discounted_cash":396.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY FOREARM CAST","code_information":[{"code":"3612907501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29075","type":"HCPCS"}],"standard_charges":[{"gross_charge":260.32,"discounted_cash":260.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY HAND/WRIST CAST","code_information":[{"code":"3612908501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29085","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.24,"discounted_cash":477.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY LONG ARM SPLINT","code_information":[{"code":"3612910501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29105","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.77,"discounted_cash":396.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY FOREARM SPLINT,STATIC","code_information":[{"code":"3612912501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29125","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.51,"discounted_cash":288.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY FINGER SPLINT,STATIC","code_information":[{"code":"3612913001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29130","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.77,"discounted_cash":396.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY FINGER SPLINT,DYNAMIC","code_information":[{"code":"3612913101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29131","type":"HCPCS"}],"standard_charges":[{"gross_charge":203.45,"discounted_cash":203.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STRAPPING OF HAND OR FINGER","code_information":[{"code":"3612928001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.03,"discounted_cash":188.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY LONG LEG CAST","code_information":[{"code":"3612934501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29345","type":"HCPCS"}],"standard_charges":[{"gross_charge":818.11,"discounted_cash":818.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY SHORT LEG CAST","code_information":[{"code":"3612940501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29405","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.77,"discounted_cash":396.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY LONG LEG SPLINT","code_information":[{"code":"3612950501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29505","type":"HCPCS"}],"standard_charges":[{"gross_charge":780.62,"discounted_cash":780.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPLY LOWER LEG SPLINT","code_information":[{"code":"3612951501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"29515","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.24,"discounted_cash":477.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVE NASAL FOREIGN BODY","code_information":[{"code":"3613030001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30300","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.54,"discounted_cash":390.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CTRL NOSEBLEED,ANTER,SIMPLE","code_information":[{"code":"3613090101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30901","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.01,"discounted_cash":378.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CTRL NOSEBLEED,ANTER,COMPLEX","code_information":[{"code":"3613090301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30903","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.89,"discounted_cash":380.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CTRL NOSEBLEED,POST,W/PACKS &/OR CAUT","code_information":[{"code":"3613090501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30905","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.89,"discounted_cash":380.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NASAL SURG PROC UNLISTED","code_information":[{"code":"3613099901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"30999","type":"HCPCS"}],"standard_charges":[{"gross_charge":378.01,"discounted_cash":378.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT EMERGENCY ENDOTRACH AIRWAY","code_information":[{"code":"3613150001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31500","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.28,"discounted_cash":601.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LARYNGOSCOPY,FLEX FIBER,DIAGNOSTIC","code_information":[{"code":"3613157501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31575","type":"HCPCS"}],"standard_charges":[{"gross_charge":287.7,"discounted_cash":287.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BRONCHOSCOPY,DIAGNOSTIC W LAVAGE","code_information":[{"code":"3613162401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"31624","type":"HCPCS"}],"standard_charges":[{"gross_charge":5053.86,"discounted_cash":5053.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERCUT BX, LUNG/MEDIASTINUM INCLUDES GUIDANCE","code_information":[{"code":"3613240801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32408","type":"HCPCS"}],"standard_charges":[{"gross_charge":4748.84,"discounted_cash":4748.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERTION INDWELLING TUNNELED PLEURAL CATHETER","code_information":[{"code":"3613255001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32550","type":"HCPCS"}],"standard_charges":[{"gross_charge":6678.41,"discounted_cash":6678.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TUBE THORACOSTOMY INCLUDES WATER SEAL","code_information":[{"code":"3613255101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32551","type":"HCPCS"}],"standard_charges":[{"gross_charge":2761.82,"discounted_cash":2761.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF","code_information":[{"code":"3613255201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32552","type":"HCPCS"}],"standard_charges":[{"gross_charge":1825.88,"discounted_cash":1825.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THORACENTESIS NEEDLE/CATH PLEURA W/IMAGING","code_information":[{"code":"3613255501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32555","type":"HCPCS"}],"standard_charges":[{"gross_charge":1599.37,"discounted_cash":1599.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ DRAINAGE PLEURA INSERT CATH W/IMAGING","code_information":[{"code":"3613255701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32557","type":"HCPCS"}],"standard_charges":[{"gross_charge":1687.95,"discounted_cash":1687.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, 1ST DAY","code_information":[{"code":"3613256101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32561","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.05,"discounted_cash":1660.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSTILL VIA CHEST TUBE AGENT FOR FIBRINOLYSIS, SUBSEQUENT","code_information":[{"code":"3613256201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"32562","type":"HCPCS"}],"standard_charges":[{"gross_charge":1660.05,"discounted_cash":1660.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERICARDIO DRAIN INDWELLING CATH PERQ W/CT GUIDANCE","code_information":[{"code":"3613301901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33019","type":"HCPCS"}],"standard_charges":[{"gross_charge":10091.71,"discounted_cash":10091.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERTION SUBQ CARDIAC RHYTHM MONITOR W/PRGRMG","code_information":[{"code":"3613328501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33285","type":"HCPCS"}],"standard_charges":[{"gross_charge":18591.42,"discounted_cash":18591.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL SUBCUTANEOUS CARDIAC RHYTHM MONITOR","code_information":[{"code":"3613328601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"33286","type":"HCPCS"}],"standard_charges":[{"gross_charge":3112.94,"discounted_cash":3112.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECTION RX EXTREMITY PSEUDOANEURYSM","code_information":[{"code":"3613600201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36002","type":"HCPCS"}],"standard_charges":[{"gross_charge":740.19,"discounted_cash":740.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECTION PROC,EXTREMITY,VENOGRAPHY","code_information":[{"code":"3613600501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36005","type":"HCPCS"}],"standard_charges":[{"gross_charge":2294.34,"discounted_cash":2294.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH IN VEIN,SVC,IVC","code_information":[{"code":"3613601001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36010","type":"HCPCS"}],"standard_charges":[{"gross_charge":1282.03,"discounted_cash":1282.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH IN LT/RT PULM ART","code_information":[{"code":"3613601401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36014","type":"HCPCS"}],"standard_charges":[{"gross_charge":1417.8,"discounted_cash":1417.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH IN SUBSEGMT PULM ART","code_information":[{"code":"3613601501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36015","type":"HCPCS"}],"standard_charges":[{"gross_charge":1773.25,"discounted_cash":1773.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTRO OF NEEDLE OR INTRACATHETER UPR/LXTR ARTERY","code_information":[{"code":"3613614001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36140","type":"HCPCS"}],"standard_charges":[{"gross_charge":963.44,"discounted_cash":963.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH AORTA","code_information":[{"code":"3613620001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36200","type":"HCPCS"}],"standard_charges":[{"gross_charge":1282.03,"discounted_cash":1282.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH SUBSUBSELECT ART,NECK","code_information":[{"code":"3613621701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36217","type":"HCPCS"}],"standard_charges":[{"gross_charge":1853.27,"discounted_cash":1853.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SLCTV CATH CAROTID/INNOM ART ANGIO XTRCRANL ART","code_information":[{"code":"3613622201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36222","type":"HCPCS"}],"standard_charges":[{"gross_charge":12915.3,"discounted_cash":12915.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SLCTV CATH VERTEBRAL ART ANGIO VERTEBRAL ARTERY","code_information":[{"code":"3613622601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36226","type":"HCPCS"}],"standard_charges":[{"gross_charge":16570.71,"discounted_cash":16570.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH SELECT ART,ABD/PEL","code_information":[{"code":"3613624501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36245","type":"HCPCS"}],"standard_charges":[{"gross_charge":1731.1,"discounted_cash":1731.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH SUBSELECT ART,ABD/PEL","code_information":[{"code":"3613624601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36246","type":"HCPCS"}],"standard_charges":[{"gross_charge":1853.27,"discounted_cash":1853.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH SUBSUBSELECT ART,ABD/PEL","code_information":[{"code":"3613624701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36247","type":"HCPCS"}],"standard_charges":[{"gross_charge":1853.27,"discounted_cash":1853.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE CATH ADDN SUBSEL ART,ABD/PEL","code_information":[{"code":"3613624801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36248","type":"HCPCS"}],"standard_charges":[{"gross_charge":981.95,"discounted_cash":981.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUORO/S&I UNI","code_information":[{"code":"3613625101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36251","type":"HCPCS"}],"standard_charges":[{"gross_charge":10918.89,"discounted_cash":10918.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SLCTV CATH 1STORD W/WO ART PUNCT/FLUOR/S&I BILAT","code_information":[{"code":"3613625201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36252","type":"HCPCS"}],"standard_charges":[{"gross_charge":10120.82,"discounted_cash":10120.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SUPSLCTV CATH 2ND+ORD RENL&ACCES ARTERY/S&I UNI","code_information":[{"code":"3613625301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36253","type":"HCPCS"}],"standard_charges":[{"gross_charge":7219.15,"discounted_cash":7219.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THER APHERESIS,RED BLOOD CELLS","code_information":[{"code":"3613651201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36512","type":"HCPCS"}],"standard_charges":[{"gross_charge":2153.61,"discounted_cash":2153.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELET DEPLETION BY VENDOR","code_information":[{"code":"3613651301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36513","type":"HCPCS"}],"standard_charges":[{"gross_charge":1340.77,"discounted_cash":1340.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THERAPEUTIC APHERESIS - PLATELET DEPLETION","code_information":[{"code":"3613651302","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36513","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.31,"discounted_cash":1117.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THER APHERESIS,PLASMA PHERESIS","code_information":[{"code":"3613651401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36514","type":"HCPCS"}],"standard_charges":[{"gross_charge":3056.4,"discounted_cash":3056.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT NON-TUNNEL CV CATH","code_information":[{"code":"3613655601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36556","type":"HCPCS"}],"standard_charges":[{"gross_charge":15926.86,"discounted_cash":15926.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT TUNNELED CV CATH W/O PORT OR PUMP","code_information":[{"code":"3613655801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36558","type":"HCPCS"}],"standard_charges":[{"gross_charge":8929.32,"discounted_cash":8929.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT TUNNELED CV CATH WITH PORT","code_information":[{"code":"3613656101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36561","type":"HCPCS"}],"standard_charges":[{"gross_charge":5450.19,"discounted_cash":5450.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERTION PICC W/O IMG GDN 5 YR/>","code_information":[{"code":"3613656901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36569","type":"HCPCS"}],"standard_charges":[{"gross_charge":4833.54,"discounted_cash":4833.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERTION PICC W/RS&I 5 YR/>","code_information":[{"code":"3613657301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36573","type":"HCPCS"}],"standard_charges":[{"gross_charge":2567.72,"discounted_cash":2567.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REPLACE TUNNELED CVC COMP W/O SUBQ PORT/PUMP","code_information":[{"code":"3613658101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36581","type":"HCPCS"}],"standard_charges":[{"gross_charge":5715.89,"discounted_cash":5715.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REPLACE TUNNELED CTR VAD COMP W/SUBQ PORT","code_information":[{"code":"3613658201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36582","type":"HCPCS"}],"standard_charges":[{"gross_charge":2063.25,"discounted_cash":2063.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL TUNNELED CV CATH W/O SUBQ PORT OR PUMP","code_information":[{"code":"3613658901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36589","type":"HCPCS"}],"standard_charges":[{"gross_charge":5689.08,"discounted_cash":5689.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL TUNNELED CV CATH W SUBQ PORT OR PUMP","code_information":[{"code":"3613659001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36590","type":"HCPCS"}],"standard_charges":[{"gross_charge":2280.78,"discounted_cash":2280.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DECLOT BY THROMBOLYTIC AGENT IMPLANT DEVICE/CATH","code_information":[{"code":"3613659301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36593","type":"HCPCS"}],"standard_charges":[{"gross_charge":1031.67,"discounted_cash":1031.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MECH REMOV INTRALUM OBSTR CV DEV THRU LUMEN","code_information":[{"code":"3613659601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36596","type":"HCPCS"}],"standard_charges":[{"gross_charge":2280.78,"discounted_cash":2280.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CONTRAST INJ CENT VEN CATH, INC FLOURO","code_information":[{"code":"3613659801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36598","type":"HCPCS"}],"standard_charges":[{"gross_charge":720.71,"discounted_cash":720.71,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT CATH,ART,PERCUT,SHORTTERM","code_information":[{"code":"3613662001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36620","type":"HCPCS"}],"standard_charges":[{"gross_charge":601.89,"discounted_cash":601.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT NEEDLE,INTRAOSSEOUS INFUSN","code_information":[{"code":"3613668001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36680","type":"HCPCS"}],"standard_charges":[{"gross_charge":562.34,"discounted_cash":562.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I","code_information":[{"code":"3613690101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36901","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.46,"discounted_cash":3054.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP","code_information":[{"code":"3613690201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36902","type":"HCPCS"}],"standard_charges":[{"gross_charge":15639.76,"discounted_cash":15639.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH","code_information":[{"code":"3613690401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36904","type":"HCPCS"}],"standard_charges":[{"gross_charge":17942.65,"discounted_cash":17942.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP","code_information":[{"code":"3613690501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36905","type":"HCPCS"}],"standard_charges":[{"gross_charge":41167.95,"discounted_cash":41167.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I","code_information":[{"code":"3613690901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"36909","type":"HCPCS"}],"standard_charges":[{"gross_charge":3054.09,"discounted_cash":3054.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVIS TRANSVEN INTRAHEP PORTOSYS SHUNT","code_information":[{"code":"3613718301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37183","type":"HCPCS"}],"standard_charges":[{"gross_charge":8910.64,"discounted_cash":8910.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA 1ST","code_information":[{"code":"3613718401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37184","type":"HCPCS"}],"standard_charges":[{"gross_charge":13212.54,"discounted_cash":13212.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRIM PRQ TRLUML MCHNL THRMBC N-COR N-ICRA SBSQ","code_information":[{"code":"3613718501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37185","type":"HCPCS"}],"standard_charges":[{"gross_charge":11892.04,"discounted_cash":11892.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SEC PRQ TRLUML THRMBC N-CORONARY N-INTRACRANIAL","code_information":[{"code":"3613718601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37186","type":"HCPCS"}],"standard_charges":[{"gross_charge":9695.67,"discounted_cash":9695.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERCUT MECH THROMBECTOMY, VENOUS","code_information":[{"code":"3613718701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37187","type":"HCPCS"}],"standard_charges":[{"gross_charge":16404.79,"discounted_cash":16404.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INS INTRVAS VC FILTR W/WO VAS ACS VSL SELXN RS&I","code_information":[{"code":"3613719101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37191","type":"HCPCS"}],"standard_charges":[{"gross_charge":14429.08,"discounted_cash":14429.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RTRVL INTRVAS VC FILTR W/WO ACS VSL SELXN RS&I","code_information":[{"code":"3613719301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37193","type":"HCPCS"}],"standard_charges":[{"gross_charge":8258.32,"discounted_cash":8258.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRQ TRANSCATHETER RTRVL INTRVAS FB WITH IMAGING","code_information":[{"code":"3613719701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37197","type":"HCPCS"}],"standard_charges":[{"gross_charge":3668.88,"discounted_cash":3668.88,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THROMBOLYSIS ARTERIAL INFUSION ICRA RS&I INIT TX","code_information":[{"code":"3613721101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37211","type":"HCPCS"}],"standard_charges":[{"gross_charge":3333.41,"discounted_cash":3333.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CESSATION THROMBOLYTIC THRPY W/CATHETER REMOVAL","code_information":[{"code":"3613721401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37214","type":"HCPCS"}],"standard_charges":[{"gross_charge":8256.77,"discounted_cash":8256.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE ILIAC ARTERY,ANGIOPLASTY, INITIAL VESSEL","code_information":[{"code":"3613722001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37220","type":"HCPCS"}],"standard_charges":[{"gross_charge":17942.65,"discounted_cash":17942.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE ILIAC ARTERY,ANGIOPLASTY/STENT, INITIAL VESSEL","code_information":[{"code":"3613722101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37221","type":"HCPCS"}],"standard_charges":[{"gross_charge":38056.99,"discounted_cash":38056.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE ILIAC ARTERY,ANGIOPLASTY/STENT, EA ADD VESSEL","code_information":[{"code":"3613722301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37223","type":"HCPCS"}],"standard_charges":[{"gross_charge":38056.99,"discounted_cash":38056.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE FEM/POP ARTERY,ANGIOPLASTY","code_information":[{"code":"3613722401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37224","type":"HCPCS"}],"standard_charges":[{"gross_charge":18550.34,"discounted_cash":18550.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE FEM/POP ARTERY,ANGIOPLASTY/ATHERECTOMY","code_information":[{"code":"3613722501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37225","type":"HCPCS"}],"standard_charges":[{"gross_charge":38357.77,"discounted_cash":38357.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE FEM/POP ARTERY,ANGIOPLASTY/STENT","code_information":[{"code":"3613722601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37226","type":"HCPCS"}],"standard_charges":[{"gross_charge":38056.99,"discounted_cash":38056.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE FEM/POP ARTERY,ANGIOPLASTY/STENT/ATHERECTOMY","code_information":[{"code":"3613722701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37227","type":"HCPCS"}],"standard_charges":[{"gross_charge":65237.2,"discounted_cash":65237.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE TIBIAL/PERON ARTERY,ANGIOPLASTY INITIAL","code_information":[{"code":"3613722801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37228","type":"HCPCS"}],"standard_charges":[{"gross_charge":38056.99,"discounted_cash":38056.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE TIBIAL/PERON ARTERY,ANGIOPLASTY/ATHERECTOMY INITIAL","code_information":[{"code":"3613722901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37229","type":"HCPCS"}],"standard_charges":[{"gross_charge":58684.96,"discounted_cash":58684.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE TIBIAL/PERON ARTERY,ANGIOPLASTY/STENT INITIAL","code_information":[{"code":"3613723001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37230","type":"HCPCS"}],"standard_charges":[{"gross_charge":58684.96,"discounted_cash":58684.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASCULARIZE TIBIAL/PERON ARTERY,ANGIOPLASTY EA ADD","code_information":[{"code":"3613723201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37232","type":"HCPCS"}],"standard_charges":[{"gross_charge":38056.99,"discounted_cash":38056.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OPEN/PERQ PLACEMENT INTRAVASCULAR STENT INITIAL","code_information":[{"code":"3613723601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37236","type":"HCPCS"}],"standard_charges":[{"gross_charge":38056.99,"discounted_cash":38056.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OPEN/PERQ PLACEMENT INTRAVASCULAR STENT SAME 1ST","code_information":[{"code":"3613723801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37238","type":"HCPCS"}],"standard_charges":[{"gross_charge":38056.99,"discounted_cash":38056.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OPEN/PERQ PLACEMT INTRAVASC STENT SAME EA ADDL","code_information":[{"code":"3613723901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37239","type":"HCPCS"}],"standard_charges":[{"gross_charge":38056.99,"discounted_cash":38056.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VASCULAR EMBOLIZATION OR OCCLUSION ARTERIAL RS&I","code_information":[{"code":"3613724201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37242","type":"HCPCS"}],"standard_charges":[{"gross_charge":35711.98,"discounted_cash":35711.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VASCULAR EMBOLIZE/OCCLUDE ORGAN TUMOR INFARCT","code_information":[{"code":"3613724301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37243","type":"HCPCS"}],"standard_charges":[{"gross_charge":35547.94,"discounted_cash":35547.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VASCULAR EMBOLIZATION OR OCCLUSION HEMORRHAGE","code_information":[{"code":"3613724401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37244","type":"HCPCS"}],"standard_charges":[{"gross_charge":35711.95,"discounted_cash":35711.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART","code_information":[{"code":"3613724601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37246","type":"HCPCS"}],"standard_charges":[{"gross_charge":17942.65,"discounted_cash":17942.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN","code_information":[{"code":"3613724801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37248","type":"HCPCS"}],"standard_charges":[{"gross_charge":17942.65,"discounted_cash":17942.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN","code_information":[{"code":"3613724901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37249","type":"HCPCS"}],"standard_charges":[{"gross_charge":9070.69,"discounted_cash":9070.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTRAVASCULAR US NONCORONARY RS&I INTIAL VESSEL","code_information":[{"code":"3613725201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37252","type":"HCPCS"}],"standard_charges":[{"gross_charge":4196.75,"discounted_cash":4196.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTRAVASCULAR US NONCORONARY RS&I ADDL VESSEL","code_information":[{"code":"3613725301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"37253","type":"HCPCS"}],"standard_charges":[{"gross_charge":700.02,"discounted_cash":700.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS","code_information":[{"code":"3613822201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38222","type":"HCPCS"}],"standard_charges":[{"gross_charge":5866.3,"discounted_cash":5866.3,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEEDLE BIOPSY, LYMPH NODE(S)","code_information":[{"code":"3613850501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38505","type":"HCPCS"}],"standard_charges":[{"gross_charge":1848.17,"discounted_cash":1848.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IDENTIFY SENTINEL NODE","code_information":[{"code":"3613879201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"38792","type":"HCPCS"}],"standard_charges":[{"gross_charge":383.19,"discounted_cash":383.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REPAIR LIP >1/2 VERT HEIGHT/COMPLEX","code_information":[{"code":"3614065401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40654","type":"HCPCS"}],"standard_charges":[{"gross_charge":4569.44,"discounted_cash":4569.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMV FB MOUTH VESTIBULE SIMPL","code_information":[{"code":"3614080401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"40804","type":"HCPCS"}],"standard_charges":[{"gross_charge":2733.29,"discounted_cash":2733.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REPAIR TONGUE LACER,2.6 CM+/COMPLX","code_information":[{"code":"3614125201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41252","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.65,"discounted_cash":714.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAINAGE OF GUM LESION","code_information":[{"code":"3614180001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"41800","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.19,"discounted_cash":759.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN ABSC PALATE/UVULA","code_information":[{"code":"3614200001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42000","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.65,"discounted_cash":714.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BIOPSY SALIVARY GLAND,NEEDLE","code_information":[{"code":"3614240001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42400","type":"HCPCS"}],"standard_charges":[{"gross_charge":2223.4,"discounted_cash":2223.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INC/DRAIN PERITONSIL ABSCESS","code_information":[{"code":"3614270001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"42700","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.19,"discounted_cash":759.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACEMENT NG/OG TUBE BY PHYSICIAN","code_information":[{"code":"3614375201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43752","type":"HCPCS"}],"standard_charges":[{"gross_charge":484.49,"discounted_cash":484.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERQ REPLACEMENT GTUBE NOT REQ REVJ GSTRST TRC","code_information":[{"code":"3614376201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"43762","type":"HCPCS"}],"standard_charges":[{"gross_charge":662.35,"discounted_cash":662.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC I&D PERIANAL ABSCESS,SUPERFICIAL","code_information":[{"code":"3614605001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"46050","type":"HCPCS"}],"standard_charges":[{"gross_charge":2680.66,"discounted_cash":2680.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INCISE EXTERNAL HEMORRHOID","code_information":[{"code":"3614608301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"46083","type":"HCPCS"}],"standard_charges":[{"gross_charge":959.13,"discounted_cash":959.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NEEDLE BIOPSY LIVER","code_information":[{"code":"3614700001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47000","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.63,"discounted_cash":1429.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHOLECYSTOSTOMY,PERCUTANEOUS, COMPLETE","code_information":[{"code":"3614749001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47490","type":"HCPCS"}],"standard_charges":[{"gross_charge":6432.86,"discounted_cash":6432.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NJX CHOLANGIO PRQ W/IMG GID RS&I EXISTING ACCESS","code_information":[{"code":"3614753101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47531","type":"HCPCS"}],"standard_charges":[{"gross_charge":8056.37,"discounted_cash":8056.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRQ PLMT BILIARY DRG CATH W/IMG GID RS&I EXTERNL","code_information":[{"code":"3614753301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47533","type":"HCPCS"}],"standard_charges":[{"gross_charge":7658.53,"discounted_cash":7658.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EXCHANGE BILIARY DRG CATHETER PRQ W/IMG GID RS&I","code_information":[{"code":"3614753601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47536","type":"HCPCS"}],"standard_charges":[{"gross_charge":7658.53,"discounted_cash":7658.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL BILIARY DUCT &/GLBLDR CALCULI PERQ RS&I","code_information":[{"code":"3614754401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47544","type":"HCPCS"}],"standard_charges":[{"gross_charge":6432.86,"discounted_cash":6432.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BILIARY ENDOSCOPY,PERCUT,W/REM, STONE(S)","code_information":[{"code":"3614755401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"47554","type":"HCPCS"}],"standard_charges":[{"gross_charge":0.93,"discounted_cash":0.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ABDOM PARACENTESIS DX/THER W IMAGING GUIDANCE","code_information":[{"code":"3614908301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49083","type":"HCPCS"}],"standard_charges":[{"gross_charge":1806.77,"discounted_cash":1806.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERCUT BIOPSY, ABDOMINAL MASS","code_information":[{"code":"3614918001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49180","type":"HCPCS"}],"standard_charges":[{"gross_charge":1714.38,"discounted_cash":1714.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AIR/CONTRAST INJECT INTO ABDOMEN","code_information":[{"code":"3614940001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1082.36,"discounted_cash":1082.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMAGE-GUIDE FLUID COLLXN DRAINAGE CATH VISC PERQ","code_information":[{"code":"3614940501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49405","type":"HCPCS"}],"standard_charges":[{"gross_charge":4940.23,"discounted_cash":4940.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMG-GUIDE FLUID COLLXN DRAINAG CATH PERITON PERQ","code_information":[{"code":"3614940601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49406","type":"HCPCS"}],"standard_charges":[{"gross_charge":4940.23,"discounted_cash":4940.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERTION TUNNEL INTRAPERITONEAL CATH W IMAGE GUIDANCE","code_information":[{"code":"3614941801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49418","type":"HCPCS"}],"standard_charges":[{"gross_charge":8927.0,"discounted_cash":8927.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAINAGE CATHETER EXCHANGE","code_information":[{"code":"3614942301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49423","type":"HCPCS"}],"standard_charges":[{"gross_charge":4761.34,"discounted_cash":4761.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CONTRAST INJ,ABSCESS/CYST VIA CATH TUBE","code_information":[{"code":"3614942401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49424","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.62,"discounted_cash":482.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT GASTROSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614944001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49440","type":"HCPCS"}],"standard_charges":[{"gross_charge":2607.94,"discounted_cash":2607.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CONVERT GASTROSTOMY-GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614944601","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49446","type":"HCPCS"}],"standard_charges":[{"gross_charge":3933.21,"discounted_cash":3933.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REPLACE GASTROSTOMY/CECOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614945001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49450","type":"HCPCS"}],"standard_charges":[{"gross_charge":1802.72,"discounted_cash":1802.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REPLACE DUODENOSTOMY/JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614945101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49451","type":"HCPCS"}],"standard_charges":[{"gross_charge":1723.05,"discounted_cash":1723.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REPLACEMENT GASTRO-JEJUNOSTOMY TUBE PERCUTANEOUS","code_information":[{"code":"3614945201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49452","type":"HCPCS"}],"standard_charges":[{"gross_charge":2163.27,"discounted_cash":2163.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CONTRAST INJECTION PERCUTANEOUOS RADIOLOGIC EVAL GI TUBE","code_information":[{"code":"3614946501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"49465","type":"HCPCS"}],"standard_charges":[{"gross_charge":276.75,"discounted_cash":276.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BIOPSY OF KIDNEY,PERCUTANEOUS","code_information":[{"code":"3615020001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50200","type":"HCPCS"}],"standard_charges":[{"gross_charge":3500.07,"discounted_cash":3500.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHANGE URETER STENT, PERCUT","code_information":[{"code":"3615038201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50382","type":"HCPCS"}],"standard_charges":[{"gross_charge":5040.22,"discounted_cash":5040.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVE RENAL TUBE W/FLUORO","code_information":[{"code":"3615038901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50389","type":"HCPCS"}],"standard_charges":[{"gross_charge":1954.2,"discounted_cash":1954.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NJX PX ANTEGRDE NFROSGRM &/URTRGRM EXSTNG ACESS","code_information":[{"code":"3615043101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50431","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.99,"discounted_cash":1844.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLMT NEPHROSTOMY CATH PRQ NEW ACCESS RS&I","code_information":[{"code":"3615043201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50432","type":"HCPCS"}],"standard_charges":[{"gross_charge":4450.11,"discounted_cash":4450.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLMT NEPHROURETERAL CATH PRQ NEW ACCESS RS&I","code_information":[{"code":"3615043301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50433","type":"HCPCS"}],"standard_charges":[{"gross_charge":5538.38,"discounted_cash":5538.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CONVERT NEPHROSTOMY CATH TO NEPHROURTRL CATH PRQ","code_information":[{"code":"3615043401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50434","type":"HCPCS"}],"standard_charges":[{"gross_charge":1844.99,"discounted_cash":1844.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EXCHANGE NEPHROSTOMY CATHETER PRQ W/IMG GID RS&I","code_information":[{"code":"3615043501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50435","type":"HCPCS"}],"standard_charges":[{"gross_charge":5949.35,"discounted_cash":5949.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ABLATION RENAL TUMOR UNILATERAL PERQ CRYOTHERAPY","code_information":[{"code":"3615059301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50593","type":"HCPCS"}],"standard_charges":[{"gross_charge":19793.01,"discounted_cash":19793.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLMT URTRL STENT PRQ PRE-EXISTING NFROS TRACT","code_information":[{"code":"3615069301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50693","type":"HCPCS"}],"standard_charges":[{"gross_charge":7516.23,"discounted_cash":7516.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLMT URTRL STNT PRQ NEW ACESS W/O SEP NFROS CATH","code_information":[{"code":"3615069401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"50694","type":"HCPCS"}],"standard_charges":[{"gross_charge":7892.04,"discounted_cash":7892.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ASPIRATION BLADDER INSERT SUPRAPUBIC CATHETER","code_information":[{"code":"3615110201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51102","type":"HCPCS"}],"standard_charges":[{"gross_charge":5034.95,"discounted_cash":5034.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECTION FOR BLADDER X-RAY","code_information":[{"code":"3615160001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51600","type":"HCPCS"}],"standard_charges":[{"gross_charge":828.42,"discounted_cash":828.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IRRIGATION OF BLADDER","code_information":[{"code":"3615170001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51700","type":"HCPCS"}],"standard_charges":[{"gross_charge":432.63,"discounted_cash":432.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT,NON-INDWELLING BLADDER CATHETER","code_information":[{"code":"3615170101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51701","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.49,"discounted_cash":132.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT,TEMP INDWELLING BLAD CATH,SIMPLE","code_information":[{"code":"3615170201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51702","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.84,"discounted_cash":186.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT,TEMP INDWELLING BLAD CATH,COMP","code_information":[{"code":"3615170301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51703","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.78,"discounted_cash":718.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHANGE OF BLADDER TUBE,SIMPLE","code_information":[{"code":"3615170501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1121.73,"discounted_cash":1121.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHANGE OF BLADDER TUBE,COMPLICATED","code_information":[{"code":"3615171001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"51710","type":"HCPCS"}],"standard_charges":[{"gross_charge":1802.72,"discounted_cash":1802.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INCIS/DRAIN SCROTUM/TESTIS,EPIDIDYM","code_information":[{"code":"3615470001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"54700","type":"HCPCS"}],"standard_charges":[{"gross_charge":6048.26,"discounted_cash":6048.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAINAGE SCROTAL WALL ABSCESS","code_information":[{"code":"3615510001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55100","type":"HCPCS"}],"standard_charges":[{"gross_charge":4752.85,"discounted_cash":4752.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX","code_information":[{"code":"3615587401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55874","type":"HCPCS"}],"standard_charges":[{"gross_charge":9660.82,"discounted_cash":9660.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLACE RADIOTHER DEVICE/MARKER, PROSTATE","code_information":[{"code":"3615587602","type":"CDM"},{"code":"0361","type":"RC"},{"code":"55876","type":"HCPCS"}],"standard_charges":[{"gross_charge":3355.84,"discounted_cash":3355.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC I&D OF VULVA/PERINEUM ABSCESS","code_information":[{"code":"3615640501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56405","type":"HCPCS"}],"standard_charges":[{"gross_charge":952.7,"discounted_cash":952.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC I&D BARTHOLIN GLAND ABSCESS","code_information":[{"code":"3615642001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"56420","type":"HCPCS"}],"standard_charges":[{"gross_charge":1999.46,"discounted_cash":1999.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVE INTRAUTERINE DEVICE","code_information":[{"code":"3615830101","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58301","type":"HCPCS"}],"standard_charges":[{"gross_charge":1000.34,"discounted_cash":1000.34,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH/INJECT HYSTEROSALPINGOGRAM","code_information":[{"code":"3615834001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"58340","type":"HCPCS"}],"standard_charges":[{"gross_charge":333.54,"discounted_cash":333.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BIOPSY OF THYROID,PERCUT","code_information":[{"code":"3616010001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"60100","type":"HCPCS"}],"standard_charges":[{"gross_charge":1525.18,"discounted_cash":1525.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERCUT ASPIRATION VERTEBRAL DISC","code_information":[{"code":"3616226701","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62267","type":"HCPCS"}],"standard_charges":[{"gross_charge":917.45,"discounted_cash":917.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE","code_information":[{"code":"3616227001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62270","type":"HCPCS"}],"standard_charges":[{"gross_charge":2144.98,"discounted_cash":2144.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR","code_information":[{"code":"3616228401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62284","type":"HCPCS"}],"standard_charges":[{"gross_charge":721.69,"discounted_cash":721.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOGRAPHY VIA LUMBAR INJECT RS&I LUMBOSACRAL","code_information":[{"code":"3616230401","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62304","type":"HCPCS"}],"standard_charges":[{"gross_charge":2057.18,"discounted_cash":2057.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYELOGRAPHY VIA LUMBAR INJECTION RS&I 2+ REGIONS","code_information":[{"code":"3616230501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62305","type":"HCPCS"}],"standard_charges":[{"gross_charge":2862.92,"discounted_cash":2862.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN","code_information":[{"code":"3616232301","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62323","type":"HCPCS"}],"standard_charges":[{"gross_charge":2164.76,"discounted_cash":2164.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIAGNOSTIC LUMBAR SPINAL PUNCTURE W/FLUOR OR CT","code_information":[{"code":"3616232801","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62328","type":"HCPCS"}],"standard_charges":[{"gross_charge":955.64,"discounted_cash":955.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC THERAPEUTIC SPINAL PNXR DRAINAGE CSF W/FLUOR/CT","code_information":[{"code":"3616232901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"62329","type":"HCPCS"}],"standard_charges":[{"gross_charge":1195.95,"discounted_cash":1195.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECTION AA&/STRD TRIGEMINAL NERVE EACH BRANCH","code_information":[{"code":"3616440001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64400","type":"HCPCS"}],"standard_charges":[{"gross_charge":1234.19,"discounted_cash":1234.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH","code_information":[{"code":"3616445001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"64450","type":"HCPCS"}],"standard_charges":[{"gross_charge":649.83,"discounted_cash":649.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMV F.B.,EYE,SUPERF CONJUNC","code_information":[{"code":"3616520501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65205","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.89,"discounted_cash":380.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMV F.B.,EYE,CORNEA,NO SLIT","code_information":[{"code":"3616522001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65220","type":"HCPCS"}],"standard_charges":[{"gross_charge":916.78,"discounted_cash":916.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMV F.B.,EYE,CORNEA,SLIT LAMP","code_information":[{"code":"3616522201","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65222","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.89,"discounted_cash":380.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL,FB,INTRAOCULAR,ANT CHAMBER/LENS","code_information":[{"code":"3616523501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"65235","type":"HCPCS"}],"standard_charges":[{"gross_charge":7014.75,"discounted_cash":7014.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC I&D EYELID BLEPHAROTOMY","code_information":[{"code":"3616770001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"67700","type":"HCPCS"}],"standard_charges":[{"gross_charge":883.63,"discounted_cash":883.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN EXT EAR ABSC/BLOOD,SIMPLE","code_information":[{"code":"3616900001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69000","type":"HCPCS"}],"standard_charges":[{"gross_charge":759.19,"discounted_cash":759.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DRAIN EXT EAR ABSC/BLOOD,COMPLIC","code_information":[{"code":"3616900501","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69005","type":"HCPCS"}],"standard_charges":[{"gross_charge":4752.85,"discounted_cash":4752.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMV EXT CANAL FOREIGN BODY","code_information":[{"code":"3616920001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69200","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.54,"discounted_cash":390.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL IMPACTED CERUMEN IRRIGATION/LVG UNILAT","code_information":[{"code":"3616920901","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69209","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.54,"discounted_cash":390.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT","code_information":[{"code":"3616921001","type":"CDM"},{"code":"0361","type":"RC"},{"code":"69210","type":"HCPCS"}],"standard_charges":[{"gross_charge":390.54,"discounted_cash":390.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENERAL ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000001","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":5926.81,"discounted_cash":5926.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GENERAL ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000002","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":67.33,"discounted_cash":67.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REGIONAL ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000003","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":2573.35,"discounted_cash":2573.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REGIONAL ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000004","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":25.67,"discounted_cash":25.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - INITIAL 30 MINUTES","code_information":[{"code":"3700000005","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":2653.4,"discounted_cash":2653.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MONITORED ANESTHESIA CARE ANESTHESIA TIME - EACH ADDL MINUTE","code_information":[{"code":"3700000006","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":23.53,"discounted_cash":23.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ANES LABOR EPIDURAL","code_information":[{"code":"3700000007","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":2205.29,"discounted_cash":2205.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC AN EPIDURAL BLOCK CHARGE","code_information":[{"code":"3700000014","type":"CDM"},{"code":"0370","type":"RC"}],"standard_charges":[{"gross_charge":2071.05,"discounted_cash":2071.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJ,ANES AGENT,FEMORAL NERVE,SINGLE","code_information":[{"code":"3706444701","type":"CDM"},{"code":"0370","type":"RC"},{"code":"64447","type":"HCPCS"}],"standard_charges":[{"gross_charge":2144.98,"discounted_cash":2144.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS <5 YRS","code_information":[{"code":"3709915101","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99151","type":"HCPCS"}],"standard_charges":[{"gross_charge":718.5,"discounted_cash":718.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOD SED SAME PHYS/QHP INITIAL 15 MINS 5/> YRS","code_information":[{"code":"3709915201","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.43,"discounted_cash":754.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOD SED SAME PHYS/QHP INIT 15 MINS 5/> YRS GI ONLY","code_information":[{"code":"3709915202","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99152","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.43,"discounted_cash":754.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOD SED SAME PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"3709915301","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99153","type":"HCPCS"}],"standard_charges":[{"gross_charge":358.81,"discounted_cash":358.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS <5 YRS","code_information":[{"code":"3709915501","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99155","type":"HCPCS"}],"standard_charges":[{"gross_charge":995.23,"discounted_cash":995.23,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOD SED OTHER PHYS/QHP INITIAL 15 MINS 5/> YRS","code_information":[{"code":"3709915601","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99156","type":"HCPCS"}],"standard_charges":[{"gross_charge":754.77,"discounted_cash":754.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MOD SED OTHER PHYS/QHP EACH ADDL 15 MINS","code_information":[{"code":"3709915701","type":"CDM"},{"code":"0370","type":"RC"},{"code":"99157","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.66,"discounted_cash":300.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PRODUCT IRRADIATION - EACH","code_information":[{"code":"3908694501","type":"CDM"},{"code":"0390","type":"RC"},{"code":"86945","type":"HCPCS"}],"standard_charges":[{"gross_charge":186.17,"discounted_cash":186.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PRODUCT - CRYOPRECIPITATE UNIT","code_information":[{"code":"390P901201","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9012","type":"HCPCS"}],"standard_charges":[{"gross_charge":146.17,"discounted_cash":146.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PRODUCT - RBC LEUKO REDUCED UNIT","code_information":[{"code":"390P901601","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9016","type":"HCPCS"}],"standard_charges":[{"gross_charge":572.7,"discounted_cash":572.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELET PHERES LEUKOREDUCED LVDS","code_information":[{"code":"390P903502","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9035","type":"HCPCS"}],"standard_charges":[{"gross_charge":1369.61,"discounted_cash":1369.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PRODUCT - RBC LEUKO REDUCED IRRADIATED UNIT","code_information":[{"code":"390P904001","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9040","type":"HCPCS"}],"standard_charges":[{"gross_charge":1163.49,"discounted_cash":1163.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLATELETS  HLA-M  L/R  UNIT LVDS","code_information":[{"code":"390P905202","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9052","type":"HCPCS"}],"standard_charges":[{"gross_charge":2265.94,"discounted_cash":2265.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RBC LEUKOREDUCE CMV NEG IRRAD UNIT","code_information":[{"code":"390P905801","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9058","type":"HCPCS"}],"standard_charges":[{"gross_charge":823.54,"discounted_cash":823.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PRODUCT - FRESH FROZEN PLASMA 24H UNIT","code_information":[{"code":"390P905901","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9059","type":"HCPCS"}],"standard_charges":[{"gross_charge":347.5,"discounted_cash":347.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD PRODUCT - PLATELET PHERESIS PATHOGEN REDUCED","code_information":[{"code":"390P907301","type":"CDM"},{"code":"0390","type":"RC"},{"code":"P9073","type":"HCPCS"}],"standard_charges":[{"gross_charge":1734.99,"discounted_cash":1734.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BLOOD TRANSFUSION SERVICE","code_information":[{"code":"3913643001","type":"CDM"},{"code":"0391","type":"RC"},{"code":"36430","type":"HCPCS"}],"standard_charges":[{"gross_charge":1851.47,"discounted_cash":1851.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIGITAL BREAST TOMOSYNTHESIS UNILATERAL","code_information":[{"code":"4017706101","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77061","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.84,"discounted_cash":240.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIGITAL BREAST TOMOSYNTHESIS BILATERAL","code_information":[{"code":"4017706201","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77062","type":"HCPCS"}],"standard_charges":[{"gross_charge":240.84,"discounted_cash":240.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI","code_information":[{"code":"4017706505","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77065","type":"HCPCS"}],"standard_charges":[{"gross_charge":436.39,"discounted_cash":436.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI","code_information":[{"code":"4017706602","type":"CDM"},{"code":"0401","type":"RC"},{"code":"77066","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.48,"discounted_cash":714.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RAD GUIDED,PERCUT DRAINAGE,W/CATH PLACE","code_information":[{"code":"4027598901","type":"CDM"},{"code":"0402","type":"RC"},{"code":"75989","type":"HCPCS"}],"standard_charges":[{"gross_charge":3037.52,"discounted_cash":3037.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, HEAD, REAL TIME","code_information":[{"code":"4027650602","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76506","type":"HCPCS"}],"standard_charges":[{"gross_charge":1119.87,"discounted_cash":1119.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, EYE B-SCAN","code_information":[{"code":"4027651201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76512","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.76,"discounted_cash":367.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, HEAD/NECK TISSUES,REAL TIME","code_information":[{"code":"4027653603","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76536","type":"HCPCS"}],"standard_charges":[{"gross_charge":1318.96,"discounted_cash":1318.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, CHEST,REAL TIME","code_information":[{"code":"4027660401","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76604","type":"HCPCS"}],"standard_charges":[{"gross_charge":714.86,"discounted_cash":714.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US BREAST UNI REAL TIME WITH IMAGE COMPLETE","code_information":[{"code":"4027664102","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76641","type":"HCPCS"}],"standard_charges":[{"gross_charge":423.8,"discounted_cash":423.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US BREAST UNI REAL TIME WITH IMAGE LIMITED","code_information":[{"code":"4027664201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76642","type":"HCPCS"}],"standard_charges":[{"gross_charge":338.55,"discounted_cash":338.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, ABDOM,B-SCAN &/OR REAL TIME,COMPLETE","code_information":[{"code":"4027670001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76700","type":"HCPCS"}],"standard_charges":[{"gross_charge":2456.62,"discounted_cash":2456.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, ABDOMEN LIMITED","code_information":[{"code":"4027670501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76705","type":"HCPCS"}],"standard_charges":[{"gross_charge":1268.58,"discounted_cash":1268.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA","code_information":[{"code":"4027670601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76706","type":"HCPCS"}],"standard_charges":[{"gross_charge":1173.95,"discounted_cash":1173.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US,RETROPERIT, B-SCAN/REAL TIME,COMPLETE","code_information":[{"code":"4027677002","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76770","type":"HCPCS"}],"standard_charges":[{"gross_charge":1860.59,"discounted_cash":1860.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, RETROPERITNL ABD, LTD","code_information":[{"code":"4027677502","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76775","type":"HCPCS"}],"standard_charges":[{"gross_charge":1612.91,"discounted_cash":1612.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US,TRANSPLANTED KIDNEY, REAL TIME/ DOPPLER","code_information":[{"code":"4027677601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76776","type":"HCPCS"}],"standard_charges":[{"gross_charge":465.12,"discounted_cash":465.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, OB < 14 WKS, SINGLE FETUS","code_information":[{"code":"4027680101","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76801","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.57,"discounted_cash":1117.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, OB < 14 WKS, ADD'L FETUS","code_information":[{"code":"4027680201","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76802","type":"HCPCS"}],"standard_charges":[{"gross_charge":986.67,"discounted_cash":986.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US, OB >/= 14 WKS, SNGL FETUS","code_information":[{"code":"4027680501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1742.29,"discounted_cash":1742.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US,PREGNANT UTERUS,LIMITED, 1/> FETUSES","code_information":[{"code":"4027681501","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76815","type":"HCPCS"}],"standard_charges":[{"gross_charge":1742.29,"discounted_cash":1742.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US,PREGNANT UTERUS,F/U,TRANSABD APP","code_information":[{"code":"4027681601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76816","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.76,"discounted_cash":367.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US,PREGNANT UTERUS,TRANSVAGINAL","code_information":[{"code":"4027681701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76817","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.55,"discounted_cash":966.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FETAL BIOPHYSICAL PROFILE","code_information":[{"code":"4027681801","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76818","type":"HCPCS"}],"standard_charges":[{"gross_charge":1729.7,"discounted_cash":1729.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FETAL BIOPHYS PROF,W/O NST","code_information":[{"code":"4027681901","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76819","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.57,"discounted_cash":1117.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DOPPLER FETAL UMBILICAL ARTERY","code_information":[{"code":"4027682001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76820","type":"HCPCS"}],"standard_charges":[{"gross_charge":396.81,"discounted_cash":396.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECHOGRAPHY,TRANSVAGINAL","code_information":[{"code":"4027683002","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76830","type":"HCPCS"}],"standard_charges":[{"gross_charge":1117.57,"discounted_cash":1117.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECHO,PELVIC (NONOBSTETRIC)","code_information":[{"code":"4027685601","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76856","type":"HCPCS"}],"standard_charges":[{"gross_charge":1960.68,"discounted_cash":1960.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SONO PELVIS LIMITED","code_information":[{"code":"4027685701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76857","type":"HCPCS"}],"standard_charges":[{"gross_charge":928.32,"discounted_cash":928.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECHO,SCROTUM & CONTENTS","code_information":[{"code":"4027687001","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76870","type":"HCPCS"}],"standard_charges":[{"gross_charge":1129.65,"discounted_cash":1129.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECHO,TRANSRECTAL,PROSTATE VOL","code_information":[{"code":"4027687301","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76873","type":"HCPCS"}],"standard_charges":[{"gross_charge":1621.69,"discounted_cash":1621.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US COMPLETE JOINT REAL TIME W IMAGE DOCUMENTATION","code_information":[{"code":"4027688121","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76881","type":"HCPCS"}],"standard_charges":[{"gross_charge":890.66,"discounted_cash":890.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG","code_information":[{"code":"4027688202","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76882","type":"HCPCS"}],"standard_charges":[{"gross_charge":321.57,"discounted_cash":321.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC US GUIDE, VASCULAR ACCESS","code_information":[{"code":"4027693701","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76937","type":"HCPCS"}],"standard_charges":[{"gross_charge":1181.24,"discounted_cash":1181.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SONO GUIDE NEEDLE BIOPSY","code_information":[{"code":"4027694232","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76942","type":"HCPCS"}],"standard_charges":[{"gross_charge":1381.36,"discounted_cash":1381.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ULTRASONIC GUIDANCE, INTRAOPERATIVE","code_information":[{"code":"4027699802","type":"CDM"},{"code":"0402","type":"RC"},{"code":"76998","type":"HCPCS"}],"standard_charges":[{"gross_charge":1819.9,"discounted_cash":1819.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SCREENING DIGITAL BREAST TOMOSYNTHESIS BI","code_information":[{"code":"4037706302","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77063","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.27,"discounted_cash":98.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD","code_information":[{"code":"4037706702","type":"CDM"},{"code":"0403","type":"RC"},{"code":"77067","type":"HCPCS"}],"standard_charges":[{"gross_charge":348.69,"discounted_cash":348.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PET IMAGING WHOLE BODY","code_information":[{"code":"4047881301","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78813","type":"HCPCS"}],"standard_charges":[{"gross_charge":3346.64,"discounted_cash":3346.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PET IMAGING CT ATTENUATION SKULL BASE MID-THIGH","code_information":[{"code":"4047881501","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78815","type":"HCPCS"}],"standard_charges":[{"gross_charge":10520.87,"discounted_cash":10520.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PET IMAGING FOR CT ATTENUATION WHOLE BODY","code_information":[{"code":"4047881601","type":"CDM"},{"code":"0404","type":"RC"},{"code":"78816","type":"HCPCS"}],"standard_charges":[{"gross_charge":11532.35,"discounted_cash":11532.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT VENT MGMT, INPATIENT, INITIAL DAY","code_information":[{"code":"4109400201","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1360.82,"discounted_cash":1360.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT VENT MGMT, NEONATE INPATIENT, INITIAL DAY","code_information":[{"code":"4109400204","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94002","type":"HCPCS"}],"standard_charges":[{"gross_charge":1360.82,"discounted_cash":1360.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT VENT MGMT, INPATIENT, SUBQ DAY","code_information":[{"code":"4109400301","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94003","type":"HCPCS"}],"standard_charges":[{"gross_charge":799.29,"discounted_cash":799.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT INHALATION TREATMENT","code_information":[{"code":"4109464001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.72,"discounted_cash":196.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT MDI/DPI","code_information":[{"code":"4109464002","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.72,"discounted_cash":196.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT INDUCED SPUTUM","code_information":[{"code":"4109464003","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.72,"discounted_cash":196.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT HAND HELD NEBULIZER","code_information":[{"code":"4109464004","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94640","type":"HCPCS"}],"standard_charges":[{"gross_charge":491.79,"discounted_cash":491.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT PENTAMADINE TX","code_information":[{"code":"4109464201","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94642","type":"HCPCS"}],"standard_charges":[{"gross_charge":573.06,"discounted_cash":573.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CONTINUOUS INHALATION TX, 1ST HR","code_information":[{"code":"4109464401","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94644","type":"HCPCS"}],"standard_charges":[{"gross_charge":290.03,"discounted_cash":290.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT CPAP NON-EMERGENT","code_information":[{"code":"4109466001","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.65,"discounted_cash":699.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT BIPAP NON-EMERGENT","code_information":[{"code":"4109466006","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94660","type":"HCPCS"}],"standard_charges":[{"gross_charge":699.65,"discounted_cash":699.65,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DEMO &/OR EVAL,PT USE,AEROSOL DEVICE","code_information":[{"code":"4109466401","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94664","type":"HCPCS"}],"standard_charges":[{"gross_charge":183.21,"discounted_cash":183.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHEST WALL MANIPULATION,INITIAL","code_information":[{"code":"4109466701","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94667","type":"HCPCS"}],"standard_charges":[{"gross_charge":430.17,"discounted_cash":430.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CHEST WALL MANIPULATION,SUBSEQUENT","code_information":[{"code":"4109466801","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94668","type":"HCPCS"}],"standard_charges":[{"gross_charge":234.59,"discounted_cash":234.59,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MECHANICAL CHEST WALL OSCILLATION LUNG FUNCTION","code_information":[{"code":"4109466901","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94669","type":"HCPCS"}],"standard_charges":[{"gross_charge":697.05,"discounted_cash":697.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BREATH RECORDING, INFANT","code_information":[{"code":"4109477201","type":"CDM"},{"code":"0410","type":"RC"},{"code":"94772","type":"HCPCS"}],"standard_charges":[{"gross_charge":1374.08,"discounted_cash":1374.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OTH RESP PROC, INDIV","code_information":[{"code":"410G023801","type":"CDM"},{"code":"0410","type":"RC"},{"code":"G0238","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.73,"discounted_cash":106.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT APPL MLT-LAYER VENOUS WOUND COMPRESS BELOW KNEE","code_information":[{"code":"4202958101","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29581","type":"HCPCS"}],"standard_charges":[{"gross_charge":477.24,"discounted_cash":477.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC APPL MLTLAYR COMPRES SYS UPARM LWARM HAND&FINGER","code_information":[{"code":"4202958401","type":"CDM"},{"code":"0420","type":"RC"},{"code":"29584","type":"HCPCS"}],"standard_charges":[{"gross_charge":482.15,"discounted_cash":482.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT BIOFEEDBACK TRAINING,ANY MODALITY","code_information":[{"code":"4209090101","type":"CDM"},{"code":"0420","type":"RC"},{"code":"90901","type":"HCPCS"}],"standard_charges":[{"gross_charge":288.89,"discounted_cash":288.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT BIOFEED PERINEAL / RECTAL INIT 15 MIN","code_information":[{"code":"4209091201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.21,"discounted_cash":231.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BIOFEED PERINEAL / RECTAL ADDITIONAL 15 MIN","code_information":[{"code":"4209091301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.39,"discounted_cash":228.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CANALITH REPOSITIONING PROCEDURE, PER DAY","code_information":[{"code":"4209599201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.5,"discounted_cash":174.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT HOT OR COLD PACKS THERAPY","code_information":[{"code":"4209701001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97010","type":"HCPCS"}],"standard_charges":[{"gross_charge":96.93,"discounted_cash":96.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MECHANICAL TRACTION THERAPY","code_information":[{"code":"4209701201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97012","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.93,"discounted_cash":143.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT ELECTRIC STIMULATION THERAPY UNATTENDED","code_information":[{"code":"4209701401","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.56,"discounted_cash":95.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT VASOPNEUMATIC DEVICE THERAPY","code_information":[{"code":"4209701601","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97016","type":"HCPCS"}],"standard_charges":[{"gross_charge":132.72,"discounted_cash":132.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT INFRARED THERAPY","code_information":[{"code":"4209702601","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97026","type":"HCPCS"}],"standard_charges":[{"gross_charge":74.51,"discounted_cash":74.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT ELECTRICAL STIMULATION EACH 15 MINUTES","code_information":[{"code":"4209703201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.97,"discounted_cash":204.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT IONTOPHORESIS EACH 15 MINUTES","code_information":[{"code":"4209703301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.58,"discounted_cash":97.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT ULTRASOUND THERAPY","code_information":[{"code":"4209703501","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.86,"discounted_cash":126.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT THERAPEUTIC EXERCISES","code_information":[{"code":"4209711001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.09,"discounted_cash":155.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN","code_information":[{"code":"4209711201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.56,"discounted_cash":180.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT AQUATIC THERAPY/EXERCISES","code_information":[{"code":"4209711301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":179.93,"discounted_cash":179.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GAIT TRAINING THERAPY","code_information":[{"code":"4209711601","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97116","type":"HCPCS"}],"standard_charges":[{"gross_charge":141.51,"discounted_cash":141.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT MASSAGE THERAPY","code_information":[{"code":"4209712401","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.97,"discounted_cash":204.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT MANUAL THER TECH,1+REGIONS,EA 15 MIN","code_information":[{"code":"4209714001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.97,"discounted_cash":204.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT GROUP THERAPEUTIC PROCEDURES","code_information":[{"code":"4209715001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.5,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"4209753001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.5,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"4209753301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":119.95,"discounted_cash":119.95,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"4209753501","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.21,"discounted_cash":195.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN","code_information":[{"code":"4209754201","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":76.6,"discounted_cash":76.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT PHYSICAL PERFORMANCE TEST","code_information":[{"code":"4209775001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97750","type":"HCPCS"}],"standard_charges":[{"gross_charge":105.62,"discounted_cash":105.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN","code_information":[{"code":"4209776001","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.16,"discounted_cash":231.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PT ORTHOTICS/PROSTH MGMT &/TRAINJ SBSQ ENCTR 15 MIN","code_information":[{"code":"4209776301","type":"CDM"},{"code":"0420","type":"RC"},{"code":"97763","type":"HCPCS"}],"standard_charges":[{"gross_charge":124.78,"discounted_cash":124.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS","code_information":[{"code":"4249716101","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97161","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.99,"discounted_cash":558.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS","code_information":[{"code":"4249716201","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97162","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.99,"discounted_cash":558.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS","code_information":[{"code":"4249716301","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97163","type":"HCPCS"}],"standard_charges":[{"gross_charge":558.99,"discounted_cash":558.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS","code_information":[{"code":"4249716401","type":"CDM"},{"code":"0424","type":"RC"},{"code":"97164","type":"HCPCS"}],"standard_charges":[{"gross_charge":420.78,"discounted_cash":420.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT APPLY STRAPPING SHOULDER","code_information":[{"code":"4302924001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29240","type":"HCPCS"}],"standard_charges":[{"gross_charge":317.42,"discounted_cash":317.42,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT STRAPPING OF HAND OR FINGER","code_information":[{"code":"4302928001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29280","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.03,"discounted_cash":188.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT STRAPPING OF KNEE","code_information":[{"code":"4302953001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29530","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.89,"discounted_cash":380.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT STRAPPING; ANKLE &/OR FOOT","code_information":[{"code":"4302954001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29540","type":"HCPCS"}],"standard_charges":[{"gross_charge":249.74,"discounted_cash":249.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT STRAPPING OF TOES","code_information":[{"code":"4302955001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"29550","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.03,"discounted_cash":188.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT BIOFEED PERINEAL / RECTAL INIT 15 MIN","code_information":[{"code":"4309091201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"90912","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.21,"discounted_cash":231.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT BIOFEED PERINEAL / RECTAL ADDITIONAL 15 MIN","code_information":[{"code":"4309091301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"90913","type":"HCPCS"}],"standard_charges":[{"gross_charge":228.39,"discounted_cash":228.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT CANALITH REPOSITIONING PROCEDURE, PER DAY","code_information":[{"code":"4309599202","type":"CDM"},{"code":"0430","type":"RC"},{"code":"95992","type":"HCPCS"}],"standard_charges":[{"gross_charge":174.5,"discounted_cash":174.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT HOT OR COLD PACKS THERAPY","code_information":[{"code":"4309701001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97010","type":"HCPCS"}],"standard_charges":[{"gross_charge":24.21,"discounted_cash":24.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT ELECTRIC STIMULATION THERAPY UNATTENDED","code_information":[{"code":"4309701401","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97014","type":"HCPCS"}],"standard_charges":[{"gross_charge":95.56,"discounted_cash":95.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT PARAFFIN BATH THERAPY","code_information":[{"code":"4309701801","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97018","type":"HCPCS"}],"standard_charges":[{"gross_charge":185.47,"discounted_cash":185.47,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT WHIRLPOOL THERAPY","code_information":[{"code":"4309702201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97022","type":"HCPCS"}],"standard_charges":[{"gross_charge":522.14,"discounted_cash":522.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT ELECTRICAL STIMULATION EACH 15 MINUTES","code_information":[{"code":"4309703201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97032","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.97,"discounted_cash":204.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT IONTOPHORESIS EACH 15 MINUTES","code_information":[{"code":"4309703301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97033","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.58,"discounted_cash":97.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT ULTRASOUND THERAPY","code_information":[{"code":"4309703501","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97035","type":"HCPCS"}],"standard_charges":[{"gross_charge":126.86,"discounted_cash":126.86,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT THERAPEUTIC EXERCISES","code_information":[{"code":"4309711001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97110","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.09,"discounted_cash":155.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT NEUROMUSC REEDUCAT,1+ AREAS, EA 15 MIN","code_information":[{"code":"4309711201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97112","type":"HCPCS"}],"standard_charges":[{"gross_charge":180.56,"discounted_cash":180.56,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT AQUATIC THERAPY/EXERCISES","code_information":[{"code":"4309711301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97113","type":"HCPCS"}],"standard_charges":[{"gross_charge":225.84,"discounted_cash":225.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT MASSAGE THERAPY","code_information":[{"code":"4309712401","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97124","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.97,"discounted_cash":204.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT MANUAL THER TECH,1+REGIONS,EA 15 MIN","code_information":[{"code":"4309714001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97140","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.97,"discounted_cash":204.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT GROUP THERAPEUTIC PROCEDURES","code_information":[{"code":"4309715001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97150","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.5,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN","code_information":[{"code":"4309753001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97530","type":"HCPCS"}],"standard_charges":[{"gross_charge":202.5,"discounted_cash":202.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES","code_information":[{"code":"4309753301","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97533","type":"HCPCS"}],"standard_charges":[{"gross_charge":153.16,"discounted_cash":153.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES","code_information":[{"code":"4309753501","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97535","type":"HCPCS"}],"standard_charges":[{"gross_charge":195.21,"discounted_cash":195.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT WHEELCHAIR MNGEMENT TRAINING, EA 15 MIN","code_information":[{"code":"4309754201","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97542","type":"HCPCS"}],"standard_charges":[{"gross_charge":109.64,"discounted_cash":109.64,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT CAREGIVER TRAINING 1ST 30 MIN W/O PT","code_information":[{"code":"4309755001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97550","type":"HCPCS"}],"standard_charges":[{"gross_charge":116.39,"discounted_cash":116.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OT ORTHOTIC MGMT AND TRAINING, EACH 15 MIN","code_information":[{"code":"4309776001","type":"CDM"},{"code":"0430","type":"RC"},{"code":"97760","type":"HCPCS"}],"standard_charges":[{"gross_charge":231.16,"discounted_cash":231.16,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS","code_information":[{"code":"4349716501","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97165","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.04,"discounted_cash":511.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS","code_information":[{"code":"4349716601","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97166","type":"HCPCS"}],"standard_charges":[{"gross_charge":557.13,"discounted_cash":557.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS","code_information":[{"code":"4349716701","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97167","type":"HCPCS"}],"standard_charges":[{"gross_charge":511.04,"discounted_cash":511.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS","code_information":[{"code":"4349716801","type":"CDM"},{"code":"0434","type":"RC"},{"code":"97168","type":"HCPCS"}],"standard_charges":[{"gross_charge":243.81,"discounted_cash":243.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPEECH/HEARING THERAPY, INDIVIDUAL","code_information":[{"code":"4409250701","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92507","type":"HCPCS"}],"standard_charges":[{"gross_charge":281.58,"discounted_cash":281.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SPEECH/HEARING THERAPY, GROUP","code_information":[{"code":"4409250801","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92508","type":"HCPCS"}],"standard_charges":[{"gross_charge":123.2,"discounted_cash":123.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ORAL FUNCTION THERAPY","code_information":[{"code":"4409252601","type":"CDM"},{"code":"0440","type":"RC"},{"code":"92526","type":"HCPCS"}],"standard_charges":[{"gross_charge":263.99,"discounted_cash":263.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC  SLP COGNITIVE SKILLS DEV INIT 15 MIN","code_information":[{"code":"4409712901","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97129","type":"HCPCS"}],"standard_charges":[{"gross_charge":171.48,"discounted_cash":171.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC  SLP COGNITIVE SKILLS DEV ADDITIONAL 15 MIN","code_information":[{"code":"4409713001","type":"CDM"},{"code":"0440","type":"RC"},{"code":"97130","type":"HCPCS"}],"standard_charges":[{"gross_charge":143.38,"discounted_cash":143.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EVALUATION OF SPEECH FLUENCY (STUTTER CLUTTER)","code_information":[{"code":"4449252101","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92521","type":"HCPCS"}],"standard_charges":[{"gross_charge":354.24,"discounted_cash":354.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EVALUATION OF SPEECH SOUND PRODUCTION ARTICULATE","code_information":[{"code":"4449252201","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92522","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.06,"discounted_cash":367.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EVAL SPEECH SOUND PRODUCT LANGUAGE COMPREHENSION","code_information":[{"code":"4449252301","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92523","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.06,"discounted_cash":367.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BEHAVIORAL & QUALIT ANALYSIS VOICE AND RESONANCE","code_information":[{"code":"4449252401","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92524","type":"HCPCS"}],"standard_charges":[{"gross_charge":367.06,"discounted_cash":367.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EVAL,ORAL & PHARYNGEAL SWALLOW FUNCTION","code_information":[{"code":"4449261001","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92610","type":"HCPCS"}],"standard_charges":[{"gross_charge":456.72,"discounted_cash":456.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EVAL,SWALLOW FUNCTION,CINE/VIDEO RECORD","code_information":[{"code":"4449261101","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92611","type":"HCPCS"}],"standard_charges":[{"gross_charge":543.09,"discounted_cash":543.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ENDOSCOPIC EVAL,SWALLOW,CINE/VIDEO","code_information":[{"code":"4449261201","type":"CDM"},{"code":"0444","type":"RC"},{"code":"92612","type":"HCPCS"}],"standard_charges":[{"gross_charge":254.69,"discounted_cash":254.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STANDARDIZED COGNITIVE PERFORMANCE TESTING","code_information":[{"code":"4449612501","type":"CDM"},{"code":"0444","type":"RC"},{"code":"96125","type":"HCPCS"}],"standard_charges":[{"gross_charge":289.57,"discounted_cash":289.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EMERGENCY DEPARTMENT SEXUAL ASSAULT EXAM","code_information":[{"code":"4500000001","type":"CDM"},{"code":"0450","type":"RC"}],"standard_charges":[{"gross_charge":281.17,"discounted_cash":281.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 1","code_information":[{"code":"4509928101","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":353.03,"discounted_cash":353.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EMERGENCY DEPT VISIT LEFT BEFORE SEEING PROVIDER","code_information":[{"code":"4509928103","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99281","type":"HCPCS"}],"standard_charges":[{"gross_charge":204.18,"discounted_cash":204.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 2","code_information":[{"code":"4509928201","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99282","type":"HCPCS"}],"standard_charges":[{"gross_charge":922.55,"discounted_cash":922.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 3","code_information":[{"code":"4509928301","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99283","type":"HCPCS"}],"standard_charges":[{"gross_charge":1287.48,"discounted_cash":1287.48,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 4","code_information":[{"code":"4509928401","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99284","type":"HCPCS"}],"standard_charges":[{"gross_charge":1962.66,"discounted_cash":1962.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EMERGENCY DEPARTMENT VISIT LEVEL 5","code_information":[{"code":"4509928501","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99285","type":"HCPCS"}],"standard_charges":[{"gross_charge":3902.44,"discounted_cash":3902.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CRITICAL CARE, E/M 30-74 MINUTES","code_information":[{"code":"4509929101","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99291","type":"HCPCS"}],"standard_charges":[{"gross_charge":4947.41,"discounted_cash":4947.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CRITICAL CARE, ADDL 30 MIN","code_information":[{"code":"4509929201","type":"CDM"},{"code":"0450","type":"RC"},{"code":"99292","type":"HCPCS"}],"standard_charges":[{"gross_charge":1906.45,"discounted_cash":1906.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BREATHING CAPACITY TEST","code_information":[{"code":"4609401002","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94010","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.78,"discounted_cash":668.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EVAL OF BRONCHOSPASM","code_information":[{"code":"4609406001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94060","type":"HCPCS"}],"standard_charges":[{"gross_charge":906.43,"discounted_cash":906.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VITAL CAPACITY TEST","code_information":[{"code":"4609415002","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94150","type":"HCPCS"}],"standard_charges":[{"gross_charge":224.07,"discounted_cash":224.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC LUNG FUNCTION TEST (MBC/MVV)","code_information":[{"code":"4609420001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94200","type":"HCPCS"}],"standard_charges":[{"gross_charge":394.28,"discounted_cash":394.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PULMONARY STRESS TEST - SIMPLE","code_information":[{"code":"4609461801","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94618","type":"HCPCS"}],"standard_charges":[{"gross_charge":380.89,"discounted_cash":380.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OXYGEN UPTAKE INDIRECT EVAL - RESTING - SEPARATE PROCEDURE","code_information":[{"code":"4609469001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94690","type":"HCPCS"}],"standard_charges":[{"gross_charge":188.03,"discounted_cash":188.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PLETHYSMOGRAPHY LUNG VOLUMES W/WO AIRWAY RESIST","code_information":[{"code":"4609472601","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94726","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.25,"discounted_cash":343.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GAS DILUT/WASHOUT LUNG VOL W/WO DISTRIB VENT&VOL","code_information":[{"code":"4609472701","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94727","type":"HCPCS"}],"standard_charges":[{"gross_charge":343.25,"discounted_cash":343.25,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIFFUSING CAPACITY","code_information":[{"code":"4609472901","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94729","type":"HCPCS"}],"standard_charges":[{"gross_charge":413.11,"discounted_cash":413.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RT NONINVASV OXYGEN SATUR;SINGLE","code_information":[{"code":"4609476001","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94760","type":"HCPCS"}],"standard_charges":[{"gross_charge":92.13,"discounted_cash":92.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NONINVASV OXYGEN SATUR,MULTIPLE","code_information":[{"code":"4609476101","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94761","type":"HCPCS"}],"standard_charges":[{"gross_charge":322.54,"discounted_cash":322.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NONINVASV OXYGEN SATUT CONTINUOUS","code_information":[{"code":"4609476201","type":"CDM"},{"code":"0460","type":"RC"},{"code":"94762","type":"HCPCS"}],"standard_charges":[{"gross_charge":393.02,"discounted_cash":393.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEART/LUNG RESUSCITATION (CPR)","code_information":[{"code":"4809295001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92950","type":"HCPCS"}],"standard_charges":[{"gross_charge":1104.76,"discounted_cash":1104.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIOVERSION, ELECTIVE;EXTERN","code_information":[{"code":"4809296001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"92960","type":"HCPCS"}],"standard_charges":[{"gross_charge":1233.73,"discounted_cash":1233.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PROGRAM EVAL IMPLANTABLE IN PERSN DUAL LD PACER","code_information":[{"code":"4809328006","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93280","type":"HCPCS"}],"standard_charges":[{"gross_charge":161.19,"discounted_cash":161.19,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTERROG DEV EVAL PM/LDLS PM PHYS/QHP IN PERSON","code_information":[{"code":"4809328805","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93288","type":"HCPCS"}],"standard_charges":[{"gross_charge":98.13,"discounted_cash":98.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTERROG DEVICE EVAL HEART - CARD DEVICE INPATIENT - ICD","code_information":[{"code":"4809328904","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93289","type":"HCPCS"}],"standard_charges":[{"gross_charge":125.78,"discounted_cash":125.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EP INTERROGATION EVAL IN PERSON ICPM","code_information":[{"code":"4809329001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93290","type":"HCPCS"}],"standard_charges":[{"gross_charge":208.05,"discounted_cash":208.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ILR DEVICE INTERROGATE - CARD DEVICE INPATIENT - LOOP RECORDER (ILR)","code_information":[{"code":"4809329106","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93291","type":"HCPCS"}],"standard_charges":[{"gross_charge":83.44,"discounted_cash":83.44,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TILT TABLE EVALUATION","code_information":[{"code":"4809366001","type":"CDM"},{"code":"0480","type":"RC"},{"code":"93660","type":"HCPCS"}],"standard_charges":[{"gross_charge":857.17,"discounted_cash":857.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TRANSCATH INS DUAL-CHAMB LEADLESS PACEMKR W/ IMG COMP SYS","code_information":[{"code":"4810795T01","type":"CDM"},{"code":"0481","type":"RC"},{"code":"0795T","type":"HCPCS"}],"standard_charges":[{"gross_charge":17355.0,"discounted_cash":17355.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSER HART PACER XVENOUS VENTR","code_information":[{"code":"4813320701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33207","type":"HCPCS"}],"standard_charges":[{"gross_charge":35752.72,"discounted_cash":35752.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSER HART PACER XVENOUS ATR/VENTR","code_information":[{"code":"4813320801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33208","type":"HCPCS"}],"standard_charges":[{"gross_charge":42771.02,"discounted_cash":42771.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL INSER HEART TEMP PACER ONE CHMBR","code_information":[{"code":"4813321001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33210","type":"HCPCS"}],"standard_charges":[{"gross_charge":24650.01,"discounted_cash":24650.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL INSJ 1 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","code_information":[{"code":"4813321601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33216","type":"HCPCS"}],"standard_charges":[{"gross_charge":24650.01,"discounted_cash":24650.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL INSJ 2 TRANSVNS ELTRD PERM PACEMAKER/IMPLTBL DFB","code_information":[{"code":"4813321701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33217","type":"HCPCS"}],"standard_charges":[{"gross_charge":14904.04,"discounted_cash":14904.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL INSJ ELTRD CAR VEN SYS TM INSJ DFB/PM PLS GEN","code_information":[{"code":"4813322501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33225","type":"HCPCS"}],"standard_charges":[{"gross_charge":42771.02,"discounted_cash":42771.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL REMVL PERM PM PLSE GEN W/REPL PLSE GEN SNGL LEAD","code_information":[{"code":"4813322701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33227","type":"HCPCS"}],"standard_charges":[{"gross_charge":27742.63,"discounted_cash":27742.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REMVL PERM PM PLS GEN W/REPL PLSE GEN 2 LEAD SYS","code_information":[{"code":"4813322801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33228","type":"HCPCS"}],"standard_charges":[{"gross_charge":35752.72,"discounted_cash":35752.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL REMV PERM PACER GENERATOR","code_information":[{"code":"4813323301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33233","type":"HCPCS"}],"standard_charges":[{"gross_charge":13408.54,"discounted_cash":13408.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL REMV TRANSVEN PACER ELECTRODE,1 LEAD","code_information":[{"code":"4813323401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33234","type":"HCPCS"}],"standard_charges":[{"gross_charge":8017.96,"discounted_cash":8017.96,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL REMOVAL IMPLANTABLE DEFIB PULSE GENERATOR ONLY","code_information":[{"code":"4813324101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33241","type":"HCPCS"}],"standard_charges":[{"gross_charge":8839.8,"discounted_cash":8839.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL RMVL1/DUAL CHMBR IMPLTBL DFB ELTRD TRANSVNS XTRJ","code_information":[{"code":"4813324401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33244","type":"HCPCS"}],"standard_charges":[{"gross_charge":6386.29,"discounted_cash":6386.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL INSJ/RPLCMT PERM DFB W/TRNSVNS LDS 1/DUAL CHMBR","code_information":[{"code":"4813324901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33249","type":"HCPCS"}],"standard_charges":[{"gross_charge":98946.5,"discounted_cash":98946.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL RMVL IMPLTBL DFB PLSE GEN W/REPL PLSE GEN 1 LEAD","code_information":[{"code":"4813326201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33262","type":"HCPCS"}],"standard_charges":[{"gross_charge":107177.07,"discounted_cash":107177.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL RMVL IMPLTBL DFB PLSE GEN W/RPLCMT PLSE GEN 2 LD","code_information":[{"code":"4813326301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33263","type":"HCPCS"}],"standard_charges":[{"gross_charge":107177.07,"discounted_cash":107177.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL RMVL IMPLTBL DFB PLS GEN W/RPLCMT PLS GEN MLT LD","code_information":[{"code":"4813326401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33264","type":"HCPCS"}],"standard_charges":[{"gross_charge":107177.07,"discounted_cash":107177.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TCAT INSJ/RPL PERM LEADLESS PACEMAKER RV W/IMG","code_information":[{"code":"4813327401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33274","type":"HCPCS"}],"standard_charges":[{"gross_charge":33396.52,"discounted_cash":33396.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INSERT INTRA-AORTIC BALLOON ASST DEVICE","code_information":[{"code":"4813396701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33967","type":"HCPCS"}],"standard_charges":[{"gross_charge":5392.52,"discounted_cash":5392.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL INSJ PERQ VAD W/IMAGING ARTERY ACCESS ONLY","code_information":[{"code":"4813399001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"33990","type":"HCPCS"}],"standard_charges":[{"gross_charge":2523.61,"discounted_cash":2523.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - LC","code_information":[{"code":"4819292002","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":17517.2,"discounted_cash":17517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - LD","code_information":[{"code":"4819292003","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":17517.2,"discounted_cash":17517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - RC","code_information":[{"code":"4819292004","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":17517.2,"discounted_cash":17517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - LM","code_information":[{"code":"4819292005","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":17517.2,"discounted_cash":17517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ONE ART/BRANCH - RI","code_information":[{"code":"4819292006","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92920","type":"HCPCS"}],"standard_charges":[{"gross_charge":17517.2,"discounted_cash":17517.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH","code_information":[{"code":"4819292101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92921","type":"HCPCS"}],"standard_charges":[{"gross_charge":17767.12,"discounted_cash":17767.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH - LC","code_information":[{"code":"4819292102","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92921","type":"HCPCS"}],"standard_charges":[{"gross_charge":14382.99,"discounted_cash":14382.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH - LD","code_information":[{"code":"4819292103","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92921","type":"HCPCS"}],"standard_charges":[{"gross_charge":14382.99,"discounted_cash":14382.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONARY ANGIOPLASTY ADDL BRANCH - RC","code_information":[{"code":"4819292104","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92921","type":"HCPCS"}],"standard_charges":[{"gross_charge":14382.99,"discounted_cash":14382.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRQ TRLUML CORONARY BYP GRFT REVASC ONE VESSEL","code_information":[{"code":"4819293701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92937","type":"HCPCS"}],"standard_charges":[{"gross_charge":26985.75,"discounted_cash":26985.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRQ TRLUML CORONRY TOT OCCLUS REVASC MI ONE VSL","code_information":[{"code":"4819294101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92941","type":"HCPCS"}],"standard_charges":[{"gross_charge":26985.75,"discounted_cash":26985.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRQ TRLUML CORONRY CHRONIC OCCLUS REVASC ONE VSL","code_information":[{"code":"4819294301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92943","type":"HCPCS"}],"standard_charges":[{"gross_charge":26985.75,"discounted_cash":26985.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PRQ TRLUML CORONRY CHRNIC OCCLUS REVASC ADDL VSL","code_information":[{"code":"4819294401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92944","type":"HCPCS"}],"standard_charges":[{"gross_charge":19119.7,"discounted_cash":19119.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PERC TRANSLUMINAL CORONARY LITHO","code_information":[{"code":"4819297201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92972","type":"HCPCS"}],"standard_charges":[{"gross_charge":13897.98,"discounted_cash":13897.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PRQ TRANSLUMINAL CORONARY MECHANICL THROMBECTOMY","code_information":[{"code":"4819297301","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92973","type":"HCPCS"}],"standard_charges":[{"gross_charge":9305.52,"discounted_cash":9305.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH INTRAVASC US,HEART,1ST VESSEL","code_information":[{"code":"4819297801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":2792.41,"discounted_cash":2792.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH INTRAVASC US,HEART,1ST VESSEL - LC","code_information":[{"code":"4819297802","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":3886.26,"discounted_cash":3886.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH INTRAVASC US,HEART,1ST VESSEL - LD","code_information":[{"code":"4819297803","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":3886.26,"discounted_cash":3886.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH INTRAVASC US,HEART,1ST VESSEL - RC","code_information":[{"code":"4819297804","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92978","type":"HCPCS"}],"standard_charges":[{"gross_charge":3886.26,"discounted_cash":3886.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH INTRAVASC CORONARY SONO,ADDN VESSEL","code_information":[{"code":"4819297901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":2792.41,"discounted_cash":2792.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH INTRAVASC CORONARY SONO,ADDN VESSEL - LC","code_information":[{"code":"4819297902","type":"CDM"},{"code":"0481","type":"RC"},{"code":"92979","type":"HCPCS"}],"standard_charges":[{"gross_charge":2675.49,"discounted_cash":2675.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RIGHT HEART CATH O2 SATURATION & CARDIAC OUTPUT","code_information":[{"code":"4819345101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93451","type":"HCPCS"}],"standard_charges":[{"gross_charge":10979.04,"discounted_cash":10979.04,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP","code_information":[{"code":"4819345401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93454","type":"HCPCS"}],"standard_charges":[{"gross_charge":13796.53,"discounted_cash":13796.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP, BYPASS ANGIO","code_information":[{"code":"4819345501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93455","type":"HCPCS"}],"standard_charges":[{"gross_charge":16106.41,"discounted_cash":16106.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PLACE/CORONARY ANGIO, IMG SUPER/INTERP,W RIGHT HEART CATH","code_information":[{"code":"4819345601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93456","type":"HCPCS"}],"standard_charges":[{"gross_charge":23275.75,"discounted_cash":23275.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,W LEFT HEART VENTRICULOGRAPHY","code_information":[{"code":"4819345801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93458","type":"HCPCS"}],"standard_charges":[{"gross_charge":15262.8,"discounted_cash":15262.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP, BYPASS ANGIO,W L HRT VENTRIC","code_information":[{"code":"4819345901","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93459","type":"HCPCS"}],"standard_charges":[{"gross_charge":17572.72,"discounted_cash":17572.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PLACE/CORON ANGIO, IMG SUPER/INTERP,R&L HRT CATH, L HRT VENTRIC","code_information":[{"code":"4819346001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93460","type":"HCPCS"}],"standard_charges":[{"gross_charge":23214.22,"discounted_cash":23214.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CATH PLACE/COR ANG,IMG SUPR/INTRP,BYPASS ANG, R&L CATH, L HRT VENTRIC","code_information":[{"code":"4819346101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93461","type":"HCPCS"}],"standard_charges":[{"gross_charge":26881.54,"discounted_cash":26881.54,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INJECT SUPRAVALVULAR AORTOGRAPHY DURING HEART CATH","code_information":[{"code":"4819356701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93567","type":"HCPCS"}],"standard_charges":[{"gross_charge":1027.26,"discounted_cash":1027.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEART FLOW RESERV MEASURE,INIT VESSL","code_information":[{"code":"4819357101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93571","type":"HCPCS"}],"standard_charges":[{"gross_charge":3027.78,"discounted_cash":3027.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEART FLOW RESERV MEASURE,ADDN VESSL","code_information":[{"code":"4819357201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93572","type":"HCPCS"}],"standard_charges":[{"gross_charge":3027.78,"discounted_cash":3027.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EVAL CARDIOVERT LEADS/PULS GEN","code_information":[{"code":"4819364101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"93641","type":"HCPCS"}],"standard_charges":[{"gross_charge":5244.29,"discounted_cash":5244.29,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL PTA PLCMT DRUG ELUTING SNGL STENT MAJ COR VESSEL","code_information":[{"code":"481C960001","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"gross_charge":34284.81,"discounted_cash":34284.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL PTA PLCMT DRUG ELUTING ADDITIONAL STENT MAJ COR VESSEL","code_information":[{"code":"481C960101","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9601","type":"HCPCS"}],"standard_charges":[{"gross_charge":34284.81,"discounted_cash":34284.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL REVAS COR GRAFT W DRUG STENT PLCMT SINGLE","code_information":[{"code":"481C960401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"gross_charge":34284.81,"discounted_cash":34284.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL REVAS COR GRAFT W DRUG STENT PLCMT ADDITIONAL","code_information":[{"code":"481C960501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9605","type":"HCPCS"}],"standard_charges":[{"gross_charge":34284.81,"discounted_cash":34284.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL AMI REVAS W DRUG STENT PLCMT SINGLE","code_information":[{"code":"481C960601","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9606","type":"HCPCS"}],"standard_charges":[{"gross_charge":34284.81,"discounted_cash":34284.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CCL REVAS CHRON OCCL W DRUG STENT PLCMT SINGLE","code_information":[{"code":"481C960701","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"gross_charge":34284.81,"discounted_cash":34284.81,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASC ENDOVAS ANY VESSEL W/ IV LITHO/ANGIO","code_information":[{"code":"481C976401","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"gross_charge":16043.22,"discounted_cash":16043.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASC ENDOVAS ANY VESSEL W/ IV LITHO/ANGIO/STENT","code_information":[{"code":"481C976501","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"gross_charge":21058.31,"discounted_cash":21058.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC REVASC TIBIAL/PERONEAL ART W/ IV LITHO","code_information":[{"code":"481C977201","type":"CDM"},{"code":"0481","type":"RC"},{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"gross_charge":16043.22,"discounted_cash":16043.22,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ILIAC ART ANGIO,CARDIAC CATH","code_information":[{"code":"481G027801","type":"CDM"},{"code":"0481","type":"RC"},{"code":"G0278","type":"HCPCS"}],"standard_charges":[{"gross_charge":5878.52,"discounted_cash":5878.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIAC STRESS TEST EXERCISE/PHARM - TRACING ONLY","code_information":[{"code":"4829301701","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.14,"discounted_cash":1137.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, EXERCISE","code_information":[{"code":"4829301702","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":2445.9,"discounted_cash":2445.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC CARDIAC STRESS TST,TRACING - STRESS TEST ONLY, PHARM","code_information":[{"code":"4829301752","type":"CDM"},{"code":"0482","type":"RC"},{"code":"93017","type":"HCPCS"}],"standard_charges":[{"gross_charge":1137.14,"discounted_cash":1137.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECHO XTHORACIC,CONG ANOM,COMPLETE","code_information":[{"code":"4839330302","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93303","type":"HCPCS"}],"standard_charges":[{"gross_charge":1798.35,"discounted_cash":1798.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TTE W/DOPPLER COMPLETE - TTE COMPLETE","code_information":[{"code":"4839330602","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":3827.72,"discounted_cash":3827.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TTE W/DOPPLER W OR WO FOL W CONTRAST","code_information":[{"code":"4839330603","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93306","type":"HCPCS"}],"standard_charges":[{"gross_charge":3827.72,"discounted_cash":3827.72,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECHO HEART XTHORACIC,COMPLETE, W/O DOPPLER","code_information":[{"code":"4839330702","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93307","type":"HCPCS"}],"standard_charges":[{"gross_charge":1826.91,"discounted_cash":1826.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TTE F-UP OR LMTD W OR WO FOL W CONTRAST","code_information":[{"code":"4839330807","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1030.61,"discounted_cash":1030.61,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TTE F-UP OR LMTD - TTE LIMITED W/ COLOR","code_information":[{"code":"4839330809","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.58,"discounted_cash":751.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TTE F-UP OR LMTD - TTE LIMITED W/ DOPPLER AND COLOR","code_information":[{"code":"4839330810","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":751.58,"discounted_cash":751.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TTE F-UP OR LMTD W/ DOPPLER/COLOR W OR WO FOL W CONT","code_information":[{"code":"4839330811","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93308","type":"HCPCS"}],"standard_charges":[{"gross_charge":1448.8,"discounted_cash":1448.8,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TEE COMPLETE W OR WO FOL W CONTRAST","code_information":[{"code":"4839331204","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":2513.4,"discounted_cash":2513.4,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ DOPPLER & COLOR","code_information":[{"code":"4839331206","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":3821.6,"discounted_cash":3821.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECHO TRANSESOPHAGEAL - TEE COMPLETE W/ COLOR","code_information":[{"code":"4839331208","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93312","type":"HCPCS"}],"standard_charges":[{"gross_charge":1719.63,"discounted_cash":1719.63,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DOPPLER ECHO HEART,COMPLETE","code_information":[{"code":"4839332007","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93320","type":"HCPCS"}],"standard_charges":[{"gross_charge":1186.2,"discounted_cash":1186.2,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DOPPLER ECHO HEART,LIMITED,F/U","code_information":[{"code":"4839332104","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93321","type":"HCPCS"}],"standard_charges":[{"gross_charge":418.9,"discounted_cash":418.9,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DOPPLER COLOR FLOW VELOCITY MAP","code_information":[{"code":"4839332527","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93325","type":"HCPCS"}],"standard_charges":[{"gross_charge":966.55,"discounted_cash":966.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC STRESS TTE ONLY - ECHOCARDIOGRAM EXERCISE STRESS TEST","code_information":[{"code":"4839335003","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93350","type":"HCPCS"}],"standard_charges":[{"gross_charge":1673.89,"discounted_cash":1673.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MYOCRD STRAIN IMG SPECKLE TRCK ASSMT MYOCRD MECH","code_information":[{"code":"4839335601","type":"CDM"},{"code":"0483","type":"RC"},{"code":"93356","type":"HCPCS"}],"standard_charges":[{"gross_charge":803.11,"discounted_cash":803.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OFFICE OUTPATIENT NEW PT LOW LVL MDM","code_information":[{"code":"51099203PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99203","type":"HCPCS"}],"standard_charges":[{"gross_charge":541.24,"discounted_cash":541.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OFFICE OUTPATIENT NEW PT MOD LVL MDM","code_information":[{"code":"51099204PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99204","type":"HCPCS"}],"standard_charges":[{"gross_charge":695.07,"discounted_cash":695.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT MINIMAL","code_information":[{"code":"51099211PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99211","type":"HCPCS"}],"standard_charges":[{"gross_charge":151.77,"discounted_cash":151.77,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT SF MDM","code_information":[{"code":"51099212PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99212","type":"HCPCS"}],"standard_charges":[{"gross_charge":300.76,"discounted_cash":300.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT LOW LVL MDM","code_information":[{"code":"51099213PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99213","type":"HCPCS"}],"standard_charges":[{"gross_charge":360.83,"discounted_cash":360.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT MOD LVL MDM","code_information":[{"code":"51099214PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99214","type":"HCPCS"}],"standard_charges":[{"gross_charge":499.53,"discounted_cash":499.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OFFICE OUTPATIENT VISIT EST PT HIGH LVL MDM","code_information":[{"code":"51099215PB","type":"CDM"},{"code":"0510","type":"RC"},{"code":"99215","type":"HCPCS"}],"standard_charges":[{"gross_charge":668.62,"discounted_cash":668.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DISEASE MGMT INIT ASSESSMENT","code_information":[{"code":"510S031501","type":"CDM"},{"code":"0510","type":"RC"},{"code":"S0315","type":"HCPCS"}],"standard_charges":[{"gross_charge":201.02,"discounted_cash":201.02,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DISEASE MGMT REASSESSMENT","code_information":[{"code":"510S031601","type":"CDM"},{"code":"0510","type":"RC"},{"code":"S0316","type":"HCPCS"}],"standard_charges":[{"gross_charge":121.55,"discounted_cash":121.55,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, CHEST","code_information":[{"code":"6107155001","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71550","type":"HCPCS"}],"standard_charges":[{"gross_charge":3991.31,"discounted_cash":3991.31,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, CHEST, COMBO","code_information":[{"code":"6107155202","type":"CDM"},{"code":"0610","type":"RC"},{"code":"71552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6628.82,"discounted_cash":6628.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR SAFTEY IMPLANT & FOREIGN BODY ASSMT CLIN STAFF 1ST 15 MIN","code_information":[{"code":"6107601401","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76014","type":"HCPCS"}],"standard_charges":[{"gross_charge":58.85,"discounted_cash":58.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR SAFTEY IMPLANT & FOREIGN BODY ASSMT CLIN STAFF EA ADD 30 MIN","code_information":[{"code":"6107601501","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76015","type":"HCPCS"}],"standard_charges":[{"gross_charge":117.69,"discounted_cash":117.69,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR SAFETY DETERMINATION PHYSICIAN/OTHER QHP","code_information":[{"code":"6107601601","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76016","type":"HCPCS"}],"standard_charges":[{"gross_charge":210.74,"discounted_cash":210.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR SAFETY MED PHYSICS XM CUSTOMIZATION PLNG&MNTR","code_information":[{"code":"6107601701","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76017","type":"HCPCS"}],"standard_charges":[{"gross_charge":580.7,"discounted_cash":580.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR SAFETY IMPLT ELECTRONICS PREP SUPV PHYS/QHP","code_information":[{"code":"6107601801","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76018","type":"HCPCS"}],"standard_charges":[{"gross_charge":220.91,"discounted_cash":220.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR SAFETY IMPLANT POS/IMMOBL SUPV PHYS/QHP","code_information":[{"code":"6107601901","type":"CDM"},{"code":"0610","type":"RC"},{"code":"76019","type":"HCPCS"}],"standard_charges":[{"gross_charge":140.35,"discounted_cash":140.35,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI BREAST WO CONTRAST BILATERAL","code_information":[{"code":"6107704701","type":"CDM"},{"code":"0610","type":"RC"},{"code":"77047","type":"HCPCS"}],"standard_charges":[{"gross_charge":2790.66,"discounted_cash":2790.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI BRAIN","code_information":[{"code":"6117055102","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70551","type":"HCPCS"}],"standard_charges":[{"gross_charge":6014.39,"discounted_cash":6014.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI BRAIN CONTRAST","code_information":[{"code":"6117055202","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70552","type":"HCPCS"}],"standard_charges":[{"gross_charge":6888.32,"discounted_cash":6888.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI BRAIN COMBO","code_information":[{"code":"6117055302","type":"CDM"},{"code":"0611","type":"RC"},{"code":"70553","type":"HCPCS"}],"standard_charges":[{"gross_charge":8166.18,"discounted_cash":8166.18,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, CERV SPINE","code_information":[{"code":"6127214102","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72141","type":"HCPCS"}],"standard_charges":[{"gross_charge":5918.21,"discounted_cash":5918.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, CERV SPINE CONTRAST","code_information":[{"code":"6127214201","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72142","type":"HCPCS"}],"standard_charges":[{"gross_charge":6584.89,"discounted_cash":6584.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, DORSAL SPINE","code_information":[{"code":"6127214602","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72146","type":"HCPCS"}],"standard_charges":[{"gross_charge":5812.43,"discounted_cash":5812.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, DORSAL SPINE CONTRAST","code_information":[{"code":"6127214701","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72147","type":"HCPCS"}],"standard_charges":[{"gross_charge":5918.21,"discounted_cash":5918.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, LUMBAR SPINE","code_information":[{"code":"6127214802","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72148","type":"HCPCS"}],"standard_charges":[{"gross_charge":6313.43,"discounted_cash":6313.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, LUMBAR SPINE CONTRAST","code_information":[{"code":"6127214901","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72149","type":"HCPCS"}],"standard_charges":[{"gross_charge":7036.0,"discounted_cash":7036.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, CERV SPINE COMBO","code_information":[{"code":"6127215601","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72156","type":"HCPCS"}],"standard_charges":[{"gross_charge":7449.15,"discounted_cash":7449.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, DORSAL SPINE COMBO","code_information":[{"code":"6127215701","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72157","type":"HCPCS"}],"standard_charges":[{"gross_charge":7287.49,"discounted_cash":7287.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, LUMBAR SPINE COMBO","code_information":[{"code":"6127215801","type":"CDM"},{"code":"0612","type":"RC"},{"code":"72158","type":"HCPCS"}],"standard_charges":[{"gross_charge":8035.99,"discounted_cash":8035.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, TMJ","code_information":[{"code":"6147033601","type":"CDM"},{"code":"0614","type":"RC"},{"code":"70336","type":"HCPCS"}],"standard_charges":[{"gross_charge":3816.39,"discounted_cash":3816.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, PELVIS, W/O CONTRAST","code_information":[{"code":"6147219501","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72195","type":"HCPCS"}],"standard_charges":[{"gross_charge":5303.46,"discounted_cash":5303.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, PELVIS, COMBO","code_information":[{"code":"6147219701","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72197","type":"HCPCS"}],"standard_charges":[{"gross_charge":6628.82,"discounted_cash":6628.82,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR ANGIO PELVIS(MRA)","code_information":[{"code":"6147219802","type":"CDM"},{"code":"0614","type":"RC"},{"code":"72198","type":"HCPCS"}],"standard_charges":[{"gross_charge":2139.74,"discounted_cash":2139.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, UPPER EXTREMITY W/O CONTRAST","code_information":[{"code":"6147321803","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73218","type":"HCPCS"}],"standard_charges":[{"gross_charge":5812.43,"discounted_cash":5812.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI UPPER EXTREMITY COMBO","code_information":[{"code":"6147322004","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73220","type":"HCPCS"}],"standard_charges":[{"gross_charge":7171.7,"discounted_cash":7171.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, JOINT UPPER EXTREM","code_information":[{"code":"6147322106","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73221","type":"HCPCS"}],"standard_charges":[{"gross_charge":6033.99,"discounted_cash":6033.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, JOINT UPPER EXTREM W/CONTRAST","code_information":[{"code":"6147322205","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73222","type":"HCPCS"}],"standard_charges":[{"gross_charge":6263.52,"discounted_cash":6263.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, JOINT UPPER EXTREM COMBO","code_information":[{"code":"6147322306","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73223","type":"HCPCS"}],"standard_charges":[{"gross_charge":7171.7,"discounted_cash":7171.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, LOWER EXTREM","code_information":[{"code":"6147371806","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73718","type":"HCPCS"}],"standard_charges":[{"gross_charge":5034.17,"discounted_cash":5034.17,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI LWR EXTREMITY W/O&W/DYE - MR LOWER EXTREMITY W AND WO IV CONT","code_information":[{"code":"6147372008","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73720","type":"HCPCS"}],"standard_charges":[{"gross_charge":7513.07,"discounted_cash":7513.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI LOWER EXTREMITY JOINT, W/O CONTRAST","code_information":[{"code":"6147372103","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73721","type":"HCPCS"}],"standard_charges":[{"gross_charge":5302.94,"discounted_cash":5302.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, JOINT OF LEG W/CONTRAST","code_information":[{"code":"6147372207","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73722","type":"HCPCS"}],"standard_charges":[{"gross_charge":5556.92,"discounted_cash":5556.92,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, JOINT OF LEG. COMBO - MR LOWER EXTREMITY W AND WO IV CONTRAST","code_information":[{"code":"6147372305","type":"CDM"},{"code":"0614","type":"RC"},{"code":"73723","type":"HCPCS"}],"standard_charges":[{"gross_charge":7370.84,"discounted_cash":7370.84,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, ABDOMEN (MRI)","code_information":[{"code":"6147418102","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74181","type":"HCPCS"}],"standard_charges":[{"gross_charge":5303.46,"discounted_cash":5303.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, ABDOMEN W/CONTRAST","code_information":[{"code":"6147418202","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74182","type":"HCPCS"}],"standard_charges":[{"gross_charge":3969.66,"discounted_cash":3969.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, ABDOMEN, COMBO","code_information":[{"code":"6147418303","type":"CDM"},{"code":"0614","type":"RC"},{"code":"74183","type":"HCPCS"}],"standard_charges":[{"gross_charge":6692.67,"discounted_cash":6692.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI BREAST W/WO CONTRAST W/ CAD BILATERAL","code_information":[{"code":"6147704901","type":"CDM"},{"code":"0614","type":"RC"},{"code":"77049","type":"HCPCS"}],"standard_charges":[{"gross_charge":1036.6,"discounted_cash":1036.6,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, FACE, NECK","code_information":[{"code":"6157054002","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70540","type":"HCPCS"}],"standard_charges":[{"gross_charge":4884.11,"discounted_cash":4884.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRI, FACE, NECK, COMBO","code_information":[{"code":"6157054302","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70543","type":"HCPCS"}],"standard_charges":[{"gross_charge":5023.15,"discounted_cash":5023.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRA HEAD W/O CONTRAST","code_information":[{"code":"6157054401","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70544","type":"HCPCS"}],"standard_charges":[{"gross_charge":4842.58,"discounted_cash":4842.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR ANGIO, HEAD, COMBO","code_information":[{"code":"6157054601","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70546","type":"HCPCS"}],"standard_charges":[{"gross_charge":5996.36,"discounted_cash":5996.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRA NECK W/O CONTRAST","code_information":[{"code":"6157054701","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70547","type":"HCPCS"}],"standard_charges":[{"gross_charge":4797.45,"discounted_cash":4797.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MR ANGIO, NECK, COMBO","code_information":[{"code":"6157054901","type":"CDM"},{"code":"0615","type":"RC"},{"code":"70549","type":"HCPCS"}],"standard_charges":[{"gross_charge":5996.36,"discounted_cash":5996.36,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRA CHEST WO CONTRAST","code_information":[{"code":"6187155503","type":"CDM"},{"code":"0618","type":"RC"},{"code":"71555","type":"HCPCS"}],"standard_charges":[{"gross_charge":3130.93,"discounted_cash":3130.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRA ABDOMEN W/WO CONTRAST","code_information":[{"code":"618C890201","type":"CDM"},{"code":"0618","type":"RC"},{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"gross_charge":6373.32,"discounted_cash":6373.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRA CHEST W/WO CONTRAST","code_information":[{"code":"618C891101","type":"CDM"},{"code":"0618","type":"RC"},{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"gross_charge":5387.27,"discounted_cash":5387.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MRA PELVIS W/WO CONTRAST","code_information":[{"code":"618C892001","type":"CDM"},{"code":"0618","type":"RC"},{"code":"C8920","type":"HCPCS"}],"standard_charges":[{"gross_charge":2759.83,"discounted_cash":2759.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC RHIG RHOPHYLAC 300MCG/2ML NDC 44206030010","code_information":[{"code":"636J279101","type":"CDM"},{"code":"0636","type":"RC"},{"code":"J2791","type":"HCPCS"}],"standard_charges":[{"gross_charge":19.89,"discounted_cash":19.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PACU RECOVERY PHASE 1 - INITIAL 30 MINUTES","code_information":[{"code":"7100000003","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"gross_charge":3836.7,"discounted_cash":3836.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PACU RECOVERY PHASE 1 - EACH ADDL MIN","code_information":[{"code":"7100000004","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"gross_charge":28.91,"discounted_cash":28.91,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PACU RECOVERY PHASE 2 - INITIAL 30 MINUTES","code_information":[{"code":"7100000005","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"gross_charge":2877.53,"discounted_cash":2877.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PACU RECOVERY PHASE 2 - EACH ADDL MIN","code_information":[{"code":"7100000006","type":"CDM"},{"code":"0710","type":"RC"}],"standard_charges":[{"gross_charge":21.68,"discounted_cash":21.68,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FETAL NON-STRESS TEST","code_information":[{"code":"7205902501","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59025","type":"HCPCS"}],"standard_charges":[{"gross_charge":463.03,"discounted_cash":463.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSTETRICAL CARE,VAG DELIVERY ROUTINE","code_information":[{"code":"7205940901","type":"CDM"},{"code":"0720","type":"RC"},{"code":"59409","type":"HCPCS"}],"standard_charges":[{"gross_charge":3337.1,"discounted_cash":3337.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ELECTROCARDIOGRAM, TRACING - ECG 12-LEAD","code_information":[{"code":"7309300502","type":"CDM"},{"code":"0730","type":"RC"},{"code":"93005","type":"HCPCS"}],"standard_charges":[{"gross_charge":608.13,"discounted_cash":608.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 24 HOUR","code_information":[{"code":"7319322502","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.33,"discounted_cash":569.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EXT ECG RECORD CONTIN 48 HR, RECORD - HOLTER MONITOR - 48 HOUR","code_information":[{"code":"7319322503","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93225","type":"HCPCS"}],"standard_charges":[{"gross_charge":569.33,"discounted_cash":569.33,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 24 HOUR","code_information":[{"code":"7319322601","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.39,"discounted_cash":2021.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC ECG MONIT/REPRT UP TO 48 HRS - HOLTER MONITOR - 48 HOUR","code_information":[{"code":"7319322602","type":"CDM"},{"code":"0731","type":"RC"},{"code":"93226","type":"HCPCS"}],"standard_charges":[{"gross_charge":2021.39,"discounted_cash":2021.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EEG 12-26 HR W/VIDEO, TECH, REALTIME MON","code_information":[{"code":"7409571601","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95716","type":"HCPCS"}],"standard_charges":[{"gross_charge":9583.05,"discounted_cash":9583.05,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SLEEP POLYSOM 4/+ <6 YRS","code_information":[{"code":"7409578201","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95782","type":"HCPCS"}],"standard_charges":[{"gross_charge":2791.12,"discounted_cash":2791.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","code_information":[{"code":"7409581001","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":3238.85,"discounted_cash":3238.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","code_information":[{"code":"7409581101","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":3362.76,"discounted_cash":3362.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EEG,W/AWAKE & DROWSY RECORD","code_information":[{"code":"7409581601","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95816","type":"HCPCS"}],"standard_charges":[{"gross_charge":2461.39,"discounted_cash":2461.39,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EEG,W/AWAKE & ASLEEP RECORD","code_information":[{"code":"7409581901","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95819","type":"HCPCS"}],"standard_charges":[{"gross_charge":2773.51,"discounted_cash":2773.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC EEG,COMA/SLEEP RECORD ONLY","code_information":[{"code":"7409582201","type":"CDM"},{"code":"0740","type":"RC"},{"code":"95822","type":"HCPCS"}],"standard_charges":[{"gross_charge":2773.51,"discounted_cash":2773.51,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 1 FIRST 5 MINUTES","code_information":[{"code":"7500000001","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":1128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"7500000002","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":21.37,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 2 FIRST 5 MINUTES","code_information":[{"code":"7500000003","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":2730.0,"discounted_cash":2730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"7500000004","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":51.73,"discounted_cash":51.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 3 FIRST 5 MINUTES","code_information":[{"code":"7500000005","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":4586.0,"discounted_cash":4586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"7500000006","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":93.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 4 FIRST 5 MINUTES","code_information":[{"code":"7500000007","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":6189.0,"discounted_cash":6189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"7500000008","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":117.27,"discounted_cash":117.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 5 FIRST 5 MINUTES","code_information":[{"code":"7500000009","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":7427.0,"discounted_cash":7427.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC GI/ENDO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"7500000010","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":140.73,"discounted_cash":140.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 3 EACH ADDL MINUTE","code_information":[{"code":"75000000B1","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":93.62,"discounted_cash":93.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 1 FIRST 5 MINUTES","code_information":[{"code":"75000000B2","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":1128.0,"discounted_cash":1128.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 1 EACH ADDL MINUTE","code_information":[{"code":"75000000B3","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":21.37,"discounted_cash":21.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 2 FIRST 5 MINUTES","code_information":[{"code":"75000000B4","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":2730.0,"discounted_cash":2730.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 2 EACH ADDL MINUTE","code_information":[{"code":"75000000B5","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":51.73,"discounted_cash":51.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 3 FIRST 5 MINUTES","code_information":[{"code":"75000000B6","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":4586.0,"discounted_cash":4586.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 4 FIRST 5 MINUTES","code_information":[{"code":"75000000B8","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":6189.0,"discounted_cash":6189.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 4 EACH ADDL MINUTE","code_information":[{"code":"75000000B9","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":117.27,"discounted_cash":117.27,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 5 FIRST 5 MINUTES","code_information":[{"code":"75000000C1","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":7427.0,"discounted_cash":7427.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OR ENDO - LEVEL 5 EACH ADDL MINUTE","code_information":[{"code":"75000000C2","type":"CDM"},{"code":"0750","type":"RC"}],"standard_charges":[{"gross_charge":140.73,"discounted_cash":140.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT","code_information":[{"code":"762G037803","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - CARDIOLOGY","code_information":[{"code":"762G037804","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - RESPIRATORY","code_information":[{"code":"762G037805","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - SURGICAL","code_information":[{"code":"762G037806","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - G.I.","code_information":[{"code":"762G037809","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - RADIOLOGY","code_information":[{"code":"762G037810","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - INFUSION","code_information":[{"code":"762G037811","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - RECOVERY TIME","code_information":[{"code":"762G037812","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - REVENUE INTEGRITY","code_information":[{"code":"762G037813","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OBSERVATION CARVE-OUT - PT OT ST","code_information":[{"code":"762G037814","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0378","type":"HCPCS"}],"standard_charges":[{"gross_charge":67.45,"discounted_cash":67.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIRECT REFER HOSPITAL OBSERV","code_information":[{"code":"762G037901","type":"CDM"},{"code":"0762","type":"RC"},{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"gross_charge":1354.5,"discounted_cash":1354.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC SARS-COV-2 VACCINE ADMIN (PFIZER) 30MCG/0.3ML, 2ND DOSE","code_information":[{"code":"7710002A01","type":"CDM"},{"code":"0771","type":"RC"},{"code":"0002A","type":"HCPCS"}],"standard_charges":[{"gross_charge":69.46,"discounted_cash":69.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNIZ ADMIN,1 SINGLE/COMB VAC/TOXOID","code_information":[{"code":"7719047101","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.41,"discounted_cash":106.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNIZ ADMIN, INFLUENZA","code_information":[{"code":"7719047102","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.41,"discounted_cash":106.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNIZ ADMIN, PNEUMOCOCCAL","code_information":[{"code":"7719047103","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90471","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.41,"discounted_cash":106.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMMUNIZ,ADMIN,EACH ADDL","code_information":[{"code":"7719047201","type":"CDM"},{"code":"0771","type":"RC"},{"code":"90472","type":"HCPCS"}],"standard_charges":[{"gross_charge":106.41,"discounted_cash":106.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIALYSIS  - PERITONEAL INPATIENT W/ SINGLE EVAL","code_information":[{"code":"8009094501","type":"CDM"},{"code":"0800","type":"RC"},{"code":"90945","type":"HCPCS"}],"standard_charges":[{"gross_charge":1024.0,"discounted_cash":1024.0,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INPT HEMODIALYSIS PROCEDURE W/ PHYS/QHP SNGL EVALUATION","code_information":[{"code":"8019093501","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.07,"discounted_cash":1483.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMODIALYSIS PROCEDURE INPATIENT CRRT W/ SINGLE EVALUATION","code_information":[{"code":"8019093503","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":2417.12,"discounted_cash":2417.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMODIALYSIS INPATIENT SLOW LOW EFF DIALYSIS - SLED","code_information":[{"code":"8019093504","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90935","type":"HCPCS"}],"standard_charges":[{"gross_charge":1483.07,"discounted_cash":1483.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HEMODIALYSIS, W/ REPEATED EVALS","code_information":[{"code":"8019093701","type":"CDM"},{"code":"0801","type":"RC"},{"code":"90937","type":"HCPCS"}],"standard_charges":[{"gross_charge":2940.37,"discounted_cash":2940.37,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC BONE MARROW DONOR SEARCH TESTING","code_information":[{"code":"8150000001","type":"CDM"},{"code":"0815","type":"RC"}],"standard_charges":[{"gross_charge":1.1,"discounted_cash":1.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC UNSCHED DIALYSIS ESRD PT HOS","code_information":[{"code":"829G025701","type":"CDM"},{"code":"0829","type":"RC"},{"code":"G0257","type":"HCPCS"}],"standard_charges":[{"gross_charge":2047.62,"discounted_cash":2047.62,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MULTIPLE SLEEP LATENCY TEST W/ SCORING","code_information":[{"code":"9209580501","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95805","type":"HCPCS"}],"standard_charges":[{"gross_charge":1326.5,"discounted_cash":1326.5,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POLYSOM 6/>YRS SLEEP 4/> ADDL PARAM ATTND","code_information":[{"code":"9209581002","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95810","type":"HCPCS"}],"standard_charges":[{"gross_charge":3238.85,"discounted_cash":3238.85,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC POLYSOM 6/>YRS SLEEP W/CPAP 4/> ADDL PARAM ATTND","code_information":[{"code":"9209581102","type":"CDM"},{"code":"0920","type":"RC"},{"code":"95811","type":"HCPCS"}],"standard_charges":[{"gross_charge":6725.43,"discounted_cash":6725.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC HOME SLEEP TEST TYPE III","code_information":[{"code":"920G039902","type":"CDM"},{"code":"0920","type":"RC"},{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"gross_charge":391.15,"discounted_cash":391.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL,BILAT","code_information":[{"code":"9219388003","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93880","type":"HCPCS"}],"standard_charges":[{"gross_charge":2078.79,"discounted_cash":2078.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX SCAN EXTRACRANIAL,LIMITED","code_information":[{"code":"9219388201","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93882","type":"HCPCS"}],"standard_charges":[{"gross_charge":1147.73,"discounted_cash":1147.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NON-INVAS PHYSIOLOGIC STD EXTREMITY ART 1-2 LEVEL","code_information":[{"code":"9219392203","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93922","type":"HCPCS"}],"standard_charges":[{"gross_charge":1473.78,"discounted_cash":1473.78,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NON-INVASIVE PHYSIOLOGIC STUDY EXTREMITY 3 LEVELS","code_information":[{"code":"9219392301","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93923","type":"HCPCS"}],"standard_charges":[{"gross_charge":1530.07,"discounted_cash":1530.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC NON-INVASIVE LOWER EXTREM ART STRESS/REST, COMPLETE,BILATERAL","code_information":[{"code":"9219392401","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93924","type":"HCPCS"}],"standard_charges":[{"gross_charge":2443.49,"discounted_cash":2443.49,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX LO EXTREM ART BILAT","code_information":[{"code":"9219392502","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93925","type":"HCPCS"}],"standard_charges":[{"gross_charge":1869.74,"discounted_cash":1869.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX LO EXTREM ART UNILAT/LTD","code_information":[{"code":"9219392602","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93926","type":"HCPCS"}],"standard_charges":[{"gross_charge":2179.57,"discounted_cash":2179.57,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX UP EXTREM ART BILAT","code_information":[{"code":"9219393003","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93930","type":"HCPCS"}],"standard_charges":[{"gross_charge":1923.13,"discounted_cash":1923.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX UP EXTREM ART UNILAT/LTD","code_information":[{"code":"9219393101","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93931","type":"HCPCS"}],"standard_charges":[{"gross_charge":1927.41,"discounted_cash":1927.41,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX EXTREM VENOUS,BILAT","code_information":[{"code":"9219397001","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93970","type":"HCPCS"}],"standard_charges":[{"gross_charge":2453.08,"discounted_cash":2453.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - US DOPPLER VENOUS ARM","code_information":[{"code":"9219397102","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.45,"discounted_cash":1459.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - CV US DOPPLER VENOUS LEG","code_information":[{"code":"9219397104","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.45,"discounted_cash":1459.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - UPPER EXTREM SUPERFICIAL VEIN MAP","code_information":[{"code":"9219397107","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.45,"discounted_cash":1459.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX EXTREM VENOUS,UNI OR LTD - LOWER EXTREM SUPERFICIAL VEIN MAP","code_information":[{"code":"9219397108","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93971","type":"HCPCS"}],"standard_charges":[{"gross_charge":1459.45,"discounted_cash":1459.45,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VASCULAR STUDY - RENAL ARTERY DUPLEX","code_information":[{"code":"9219397502","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1370.08,"discounted_cash":1370.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VASC DUPLEX ABD/PEL VASC STUDY,COMPLETE","code_information":[{"code":"9219397504","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93975","type":"HCPCS"}],"standard_charges":[{"gross_charge":1413.58,"discounted_cash":1413.58,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VASCULAR STUDY - US ABDOMEN DOPPLER LIMITED","code_information":[{"code":"9219397601","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93976","type":"HCPCS"}],"standard_charges":[{"gross_charge":1430.99,"discounted_cash":1430.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC VASC DUPLEX PREOP ART/VEN DIALYSIS SHUNT PLANNING STUDY,COMPLETE UNILAT","code_information":[{"code":"9219398601","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93986","type":"HCPCS"}],"standard_charges":[{"gross_charge":1429.11,"discounted_cash":1429.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DUPLEX HEMODIALYSIS ACCESS","code_information":[{"code":"9219399001","type":"CDM"},{"code":"0921","type":"RC"},{"code":"93990","type":"HCPCS"}],"standard_charges":[{"gross_charge":947.87,"discounted_cash":947.87,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIET ASSESSMENT BRIEF","code_information":[{"code":"9420000001","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"gross_charge":13.13,"discounted_cash":13.13,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIET ASSESSMENT 31 TO 60 MINUTES","code_information":[{"code":"9420000003","type":"CDM"},{"code":"0942","type":"RC"}],"standard_charges":[{"gross_charge":209.01,"discounted_cash":209.01,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MED NUTR THER, 1ST, INDIV, EA 15 MIN","code_information":[{"code":"9429780201","type":"CDM"},{"code":"0942","type":"RC"},{"code":"97802","type":"HCPCS"}],"standard_charges":[{"gross_charge":196.99,"discounted_cash":196.99,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MED NUTR THER, SUBSQ, INDIV, EA 15 MIN","code_information":[{"code":"9429780301","type":"CDM"},{"code":"0942","type":"RC"},{"code":"97803","type":"HCPCS"}],"standard_charges":[{"gross_charge":176.66,"discounted_cash":176.66,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOBACCO USE CESSATION INTERMEDIATE 3-10 MINUTES","code_information":[{"code":"9429940601","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99406","type":"HCPCS"}],"standard_charges":[{"gross_charge":66.11,"discounted_cash":66.11,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC TOBACCO USE CESSATION INTENSIVE >10 MINUTES","code_information":[{"code":"9429940701","type":"CDM"},{"code":"0942","type":"RC"},{"code":"99407","type":"HCPCS"}],"standard_charges":[{"gross_charge":100.93,"discounted_cash":100.93,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIAB MANAGE TRN  PER INDIV","code_information":[{"code":"942G010801","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"gross_charge":155.14,"discounted_cash":155.14,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC DIAB MANAGE TRN IND/GROUP","code_information":[{"code":"942G010901","type":"CDM"},{"code":"0942","type":"RC"},{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"gross_charge":97.73,"discounted_cash":97.73,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OUTPATIENT CARDIAC REHAB W/O CONT ECG MONITOR","code_information":[{"code":"9439379701","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93797","type":"HCPCS"}],"standard_charges":[{"gross_charge":401.32,"discounted_cash":401.32,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC OUTPATIENT CARDIAC REHAB W/CONT ECG MONITORING","code_information":[{"code":"9439379801","type":"CDM"},{"code":"0943","type":"RC"},{"code":"93798","type":"HCPCS"}],"standard_charges":[{"gross_charge":261.75,"discounted_cash":261.75,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTENSIVE CARDIAC REHAB W/ EXERCISE","code_information":[{"code":"943G042201","type":"CDM"},{"code":"0943","type":"RC"},{"code":"G0422","type":"HCPCS"}],"standard_charges":[{"gross_charge":392.1,"discounted_cash":392.1,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC INTENSIVE CARDIAC REHAB W/O EXERCISE","code_information":[{"code":"943G042301","type":"CDM"},{"code":"0943","type":"RC"},{"code":"G0423","type":"HCPCS"}],"standard_charges":[{"gross_charge":305.98,"discounted_cash":305.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PULMONARY REHAB W/O OXI MONITOR PER SESSION","code_information":[{"code":"9489462501","type":"CDM"},{"code":"0948","type":"RC"},{"code":"94625","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.7,"discounted_cash":156.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PULMONARY REHAB W/ OXI MONITOR PER SESSION","code_information":[{"code":"9489462601","type":"CDM"},{"code":"0948","type":"RC"},{"code":"94626","type":"HCPCS"}],"standard_charges":[{"gross_charge":156.7,"discounted_cash":156.7,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MAINTENANCE CARDIAC REHAB","code_information":[{"code":"9970000001","type":"CDM"},{"code":"0997","type":"RC"}],"standard_charges":[{"gross_charge":71.38,"discounted_cash":71.38,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC MAINTENANCE PULMONARY REHAB","code_information":[{"code":"9970000002","type":"CDM"},{"code":"0997","type":"RC"}],"standard_charges":[{"gross_charge":59.98,"discounted_cash":59.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC PATHOLOGIST INTERPRETATION    SCREENING","code_information":[{"code":"999P300101","type":"CDM"},{"code":"0999","type":"RC"},{"code":"P3001","type":"HCPCS"}],"standard_charges":[{"gross_charge":72.24,"discounted_cash":72.24,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC FIDUCIAL MRKR LNR VISICOIL 1.10MMX1.0CM PRELOAD 2OCM NDL","code_information":[{"code":"PS1768704","type":"CDM"},{"code":"0278","type":"RC"},{"code":"A4648","type":"HCPCS"}],"standard_charges":[{"gross_charge":600.46,"discounted_cash":600.46,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"HC IMPLANT SPACEROAR HYDRGL 10ML RDTPY TRMT PROST CNCR","code_information":[{"code":"PS1814755","type":"CDM"},{"code":"0278","type":"RC"},{"code":"C1889","type":"HCPCS"}],"standard_charges":[{"gross_charge":10318.43,"discounted_cash":10318.43,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: AH HB DEL PRICE"}]},{"description":"Contrast x-ray of brain","code_information":[{"code":"70010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1437.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1342.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":960.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1042.18},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Contrast x-ray of brain","code_information":[{"code":"70015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.70,"maximum":1704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1342.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":960.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1042.18},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"X-ray eye for foreign body","code_information":[{"code":"70030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of jaw <4views","code_information":[{"code":"70100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of jaw 4/> views","code_information":[{"code":"70110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of mastoids","code_information":[{"code":"70120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of mastoids","code_information":[{"code":"70130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of middle ear","code_information":[{"code":"70134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of facial bones","code_information":[{"code":"70140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of facial bones","code_information":[{"code":"70150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Cine/video x-rays","code_information":[{"code":"76120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":377.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":251.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":273.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"CAT scan follow-up study","code_information":[{"code":"76380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":191.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":127.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":191.5},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":191.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":191.5},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":138.8},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Fluoroscopic procedure","code_information":[{"code":"76496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":377.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":251.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":273.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Ct procedure","code_information":[{"code":"76497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":191.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":127.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":191.5},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":191.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":191.5},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":138.8},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Mri procedure","code_information":[{"code":"76498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Radiographic procedure","code_information":[{"code":"76499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Echo exam of head","code_information":[{"code":"76506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ophth us b & quant a","code_information":[{"code":"76510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":414.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":387.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":277.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":414.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":414.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":414.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":300.72},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":262.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":262.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":262.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":262.6}]}]},{"description":"Ophth us quant a only","code_information":[{"code":"76511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ophth us b w/non-quant a","code_information":[{"code":"76512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo exam of eye water bath","code_information":[{"code":"76513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo exam of eye thickness","code_information":[{"code":"76514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.69,"maximum":60.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":53.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.22},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38.57},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43.68}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Complex body section x-rays","code_information":[{"code":"76102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":765.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59}]}]},{"description":"Complex body section x-ray","code_information":[{"code":"76101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":765.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59}]}]},{"description":"X-ray exam of body section","code_information":[{"code":"76100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam breast specimen","code_information":[{"code":"76098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":1216.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1216.73}]}]},{"description":"X-ray exam of fistula","code_information":[{"code":"76080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray nose to rectum","code_information":[{"code":"76010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Fluoroscope examination","code_information":[{"code":"76000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":251.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":273.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Repair venous blockage","code_information":[{"code":"75978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4578.11,"maximum":6851.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6398.64},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4578.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6851.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6851.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6851.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4966.03}]}]},{"description":"Intravascular us","code_information":[{"code":"75945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.91,"maximum":459.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":428.96},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":306.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":332.92}]}]},{"description":"Follow-up angiography","code_information":[{"code":"75898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.92,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43}]}]},{"description":"Venous sampling by catheter","code_information":[{"code":"75893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4143.48,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4}]}]},{"description":"Vein x-ray liver","code_information":[{"code":"75891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Vein x-ray liver w/hemodynam","code_information":[{"code":"75889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Vein x-ray liver w/o hemodyn","code_information":[{"code":"75887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.92,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43}]}]},{"description":"Vein x-ray liver w/hemodynam","code_information":[{"code":"75885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Vein x-ray eye socket","code_information":[{"code":"75880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1990.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43}]}]},{"description":"Vein x-ray skull epidural","code_information":[{"code":"75872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1990.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43}]}]},{"description":"Vein x-ray skull","code_information":[{"code":"75870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43}]}]},{"description":"Vein x-ray neck","code_information":[{"code":"75860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.92,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Vein x-ray adrenal glands","code_information":[{"code":"75842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4143.48,"maximum":10662.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4}]}]},{"description":"Vein x-ray adrenal gland","code_information":[{"code":"75840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Vein x-ray kidneys","code_information":[{"code":"75833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Vein x-ray kidney","code_information":[{"code":"75831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Vein x-ray chest","code_information":[{"code":"75827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.92,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43}]}]},{"description":"Vein x-ray trunk","code_information":[{"code":"75825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Vein x-ray arms/legs","code_information":[{"code":"75822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.98,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43}]}]},{"description":"Vein x-ray arm/leg","code_information":[{"code":"75820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.92,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43}]}]},{"description":"Vein x-ray spleen/liver","code_information":[{"code":"75810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2457.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43}]}]},{"description":"Nonvascular shunt x-ray","code_information":[{"code":"75809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Lymph vessel x-ray trunk","code_information":[{"code":"75807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.98,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Lymph vessel x-ray trunk","code_information":[{"code":"75805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.98,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43}]}]},{"description":"Lymph vessel x-ray arms/legs","code_information":[{"code":"75803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.98,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43}]}]},{"description":"Lymph vessel x-ray arm/leg","code_information":[{"code":"75801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":1531.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43}]}]},{"description":"Angiography, arteriovenous shunt","code_information":[{"code":"75791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.92,"maximum":1990.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6}]}]},{"description":"Artery x-rays chest","code_information":[{"code":"75756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.92,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Artery x-rays lung","code_information":[{"code":"75746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1329.92,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1858.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1329.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1990.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1442.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2457.43}]}]},{"description":"Artery x-rays lungs","code_information":[{"code":"75743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Artery x-rays lung","code_information":[{"code":"75741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Artery x-rays pelvis","code_information":[{"code":"75736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4143.48,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4}]}]},{"description":"Artery x-rays adrenals","code_information":[{"code":"75733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Artery x-rays adrenal gland","code_information":[{"code":"75731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1531.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1531.43}]}]},{"description":"Artery x-rays abdomen","code_information":[{"code":"75726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10145.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":7258.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10863.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":10863.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10863.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":7873.97},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4}]}]},{"description":"Artery x-rays arms/legs","code_information":[{"code":"75716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Artery x-rays arm/leg","code_information":[{"code":"75710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Artery x-rays spine","code_information":[{"code":"75705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10145.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":7258.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10863.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":10863.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10863.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":7873.97},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4}]}]},{"description":"Artery x-rays arm","code_information":[{"code":"75658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4143.48,"maximum":6201.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59}]}]},{"description":"Ct Angio Abdominal Arteries","code_information":[{"code":"75635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":702.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":656.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":469.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":509.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"X-ray aorta leg arteries","code_information":[{"code":"75630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Contrast exam abdominl aorta","code_information":[{"code":"75625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Contrast exam thoracic aorta","code_information":[{"code":"75605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4143.48,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10662.4}]}]},{"description":"Contrast exam thoracic aorta","code_information":[{"code":"75600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5791.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4143.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6201.05},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4494.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6231.85}]}]},{"description":"Ct angio hrt w/3d image","code_information":[{"code":"75574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":499.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":357.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":387.29},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct hrt w/3d image congen","code_information":[{"code":"75573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":499.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":357.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":387.29},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct hrt w/3d image","code_information":[{"code":"75572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":499.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":357.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":534.34},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":387.29},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct hrt w/o dye w/ca test","code_information":[{"code":"75571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.56,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":53.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.22},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38.57},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Card mri w/stress img & dye","code_information":[{"code":"75563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.70,"maximum":2776.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2593.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1855.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2012.47},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"Cardiac mri for morph w/dye","code_information":[{"code":"75561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Cardiac mri w/stress img","code_information":[{"code":"75559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":474.07,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Cardiac mri for morph","code_information":[{"code":"75557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of perineum","code_information":[{"code":"74775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":619.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray female genital tract","code_information":[{"code":"74740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":765.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray measurement of pelvis","code_information":[{"code":"74710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.17,"maximum":218.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55}]}]},{"description":"X-ray guide gu dilation","code_information":[{"code":"74485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1937.58,"maximum":4353.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2708.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2335.75,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1937.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2248.43,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2101.78},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2073.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2182.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2270.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2427.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4353.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2313.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4239.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4239.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2292.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":4239.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":4239.2}]}]},{"description":"X-ray control, cath insert","code_information":[{"code":"74480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1937.58,"maximum":2899.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2708.09},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1937.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2101.78}]}]},{"description":"X-ray control, cath insert","code_information":[{"code":"74475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1937.58,"maximum":2899.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2708.09},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1937.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2899.76},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2101.78}]}]},{"description":"X-ray exam of kidney lesion","code_information":[{"code":"74470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1777.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray urethra/bladder","code_information":[{"code":"74455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":619.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray urethra/bladder","code_information":[{"code":"74450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":619.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of penis","code_information":[{"code":"74445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":619.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray male genital tract","code_information":[{"code":"74440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":619.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Contrast x-ray bladder","code_information":[{"code":"74430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrst x-ray urinary tract","code_information":[{"code":"74400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":579.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.99},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrast x-ray of bile ducts","code_information":[{"code":"74320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.98,"maximum":1777.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64}]}]},{"description":"X-ray bile ducts/pancreas","code_information":[{"code":"74305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":765.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59}]}]},{"description":"Contrast x-rays, gallbladder","code_information":[{"code":"74291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.78,"maximum":245.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":163.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":177.66}]}]},{"description":"Contrast x-ray gallbladder","code_information":[{"code":"74290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.78,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":163.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":177.66},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrast x-ray exam of colon","code_information":[{"code":"74270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct colonography dx w/dye","code_information":[{"code":"74262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct colonography dx","code_information":[{"code":"74261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.78,"maximum":245.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":163.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":177.66}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":365.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of small bowel","code_information":[{"code":"74250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.78,"maximum":365.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":163.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":177.66},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.21,"maximum":363.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82}]}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.21,"maximum":363.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82}]}]},{"description":"Contrst x-ray uppr gi tract","code_information":[{"code":"74246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"X-ray upper gi&small intest","code_information":[{"code":"74245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.21,"maximum":363.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82}]}]},{"description":"X-ray upper gi delay w/kub","code_information":[{"code":"74241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":243.21,"maximum":363.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82}]}]},{"description":"X-ray upper gi delay w/o kub","code_information":[{"code":"74240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":243.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.98},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":263.82},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Cine/vid x-ray throat/esoph","code_information":[{"code":"74230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.78,"maximum":365.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":163.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":177.66},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Contrast x-ray esophagus","code_information":[{"code":"74220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.78,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":163.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":177.66},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Contrst x-ray exam of throat","code_information":[{"code":"74210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":163.78,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":163.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":245.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":177.66},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"X-ray exam of peritoneum","code_information":[{"code":"74190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1777.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1216.73}]}]},{"description":"Mri abdomen w/o & w/dye","code_information":[{"code":"74183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri Abdomen W/Dye","code_information":[{"code":"74182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri abdomen w/o dye","code_information":[{"code":"74181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Ct abd & pelv 1/> regns","code_information":[{"code":"74178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":938.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":876.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":627.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":680.57},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct abd & pelv w/contrast","code_information":[{"code":"74177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":938.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":876.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":627.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":680.57},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct abd & pelvis w/o contrast","code_information":[{"code":"74176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":581.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":543.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":388.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":581.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":581.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":581.95},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":421.8},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Ct angio abdom w/o & w/dye","code_information":[{"code":"74175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":702.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":656.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":469.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":509.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct angio abd&pelv w/o&w/dye","code_information":[{"code":"74174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":938.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":876.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":627.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":938.96},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":680.57},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct abdomen w/o & w/dye","code_information":[{"code":"74170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct abdomen w/dye","code_information":[{"code":"74160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct abdomen w/o dye","code_information":[{"code":"74150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam series abdomen","code_information":[{"code":"74022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of abdomen","code_information":[{"code":"74020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"X-ray exam of abdomen","code_information":[{"code":"74010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"X-ray exam of abdomen","code_information":[{"code":"74000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Mri joint lwr extr w/o&w/dye","code_information":[{"code":"73723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri Joint Of Lwr Extr W/Dye","code_information":[{"code":"73722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":685.89,"maximum":1704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"Mri jnt of lwr extre w/o dye","code_information":[{"code":"73721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mri lwr extremity w/o&w/dye","code_information":[{"code":"73720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri Lower Extremity W/Dye","code_information":[{"code":"73719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1026.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Mri Lower Extremity W/O Dye","code_information":[{"code":"73718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Ct angio lwr extr w/o&w/dye","code_information":[{"code":"73706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":702.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":656.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":469.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":509.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct lwr extremity w/o&w/dye","code_information":[{"code":"73702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct lower extremity w/dye","code_information":[{"code":"73701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct lower extremity w/o dye","code_information":[{"code":"73700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of toe(s)","code_information":[{"code":"73660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of heel","code_information":[{"code":"73650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of foot","code_information":[{"code":"73630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of foot","code_information":[{"code":"73620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Contrast x-ray of ankle","code_information":[{"code":"73615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":545.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":591.96},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of ankle","code_information":[{"code":"73600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of leg infant","code_information":[{"code":"73592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of lower leg","code_information":[{"code":"73590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Contrast x-ray of knee joint","code_information":[{"code":"73580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":545.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":591.96},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"X-ray exam of knees","code_information":[{"code":"73565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam knee 4 or more","code_information":[{"code":"73564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of knee 3","code_information":[{"code":"73562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of knee 1 or 2","code_information":[{"code":"73560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of thigh","code_information":[{"code":"73550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"X-ray exam of pelvis & hips","code_information":[{"code":"73540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Contrast x-ray of hip","code_information":[{"code":"73525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":545.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":591.96},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"X-ray exam of hips","code_information":[{"code":"73520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.17,"maximum":218.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55}]}]},{"description":"X-ray exam of hip","code_information":[{"code":"73510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"X-ray exam of hip","code_information":[{"code":"73500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Mri joint upr extr w/o&w/dye","code_information":[{"code":"73223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri joint upr extrem w/dye","code_information":[{"code":"73222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":685.89,"maximum":1704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"Mri joint upr extrem w/o dye","code_information":[{"code":"73221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mri uppr extremity w/o&w/dye","code_information":[{"code":"73220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri Upper Extremity W/Dye","code_information":[{"code":"73219","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri Upper Extremity W/O Dye","code_information":[{"code":"73218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Ct angio upr extrm w/o&w/dye","code_information":[{"code":"73206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":702.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":656.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":469.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":509.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct uppr extremity w/o&w/dye","code_information":[{"code":"73202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct upper extremity w/dye","code_information":[{"code":"73201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct upper extremity w/o dye","code_information":[{"code":"73200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of finger(s)","code_information":[{"code":"73140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of hand","code_information":[{"code":"73130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of hand","code_information":[{"code":"73120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Contrast x-ray of wrist","code_information":[{"code":"73115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":816.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":545.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":591.96},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of wrist","code_information":[{"code":"73100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of arm infant","code_information":[{"code":"73092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of forearm","code_information":[{"code":"73090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Contrast x-ray of elbow","code_information":[{"code":"73085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":545.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":591.96},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of elbow","code_information":[{"code":"73070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of humerus","code_information":[{"code":"73060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of shoulders","code_information":[{"code":"73050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Contrast x-ray of shoulder","code_information":[{"code":"73040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":545.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":591.96},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"X-ray exam of shoulder","code_information":[{"code":"73030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of shoulder","code_information":[{"code":"73020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of shoulder blade","code_information":[{"code":"73010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of collar bone","code_information":[{"code":"73000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray of lower spine disk","code_information":[{"code":"72295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1937.23,"maximum":6645.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6206.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4440.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6645.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6645.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6645.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4816.57},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1937.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2267.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4066.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4026.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4026.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2141.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":4026.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":4026.25}]}]},{"description":"Discography cerv/thor spine","code_information":[{"code":"72285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1937.23,"maximum":6645.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6206.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2181.93,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":4440.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2100.37,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":6645.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":6645.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6645.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":4816.57},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1937.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2039.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2120.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2267.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4066.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2161.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":4026.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4026.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2141.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":4026.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":4026.25}]}]},{"description":"Myelogphy 2/> spine regions","code_information":[{"code":"72270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.70,"maximum":1704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1342.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":960.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1042.18},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"Myelography l-s spine","code_information":[{"code":"72265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.70,"maximum":1704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1342.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":960.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1042.18},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"Myelography thoracic spine","code_information":[{"code":"72255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.70,"maximum":1704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1342.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":960.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1042.18},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"Myelography neck spine","code_information":[{"code":"72240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":777.70,"maximum":1704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1342.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":960.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1437.86},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1042.18},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"X-ray exam sacrum tailbone","code_information":[{"code":"72220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam si joints 3/> vws","code_information":[{"code":"72202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam si joints","code_information":[{"code":"72200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Mri pelvis w/o & w/dye","code_information":[{"code":"72197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri pelvis w/dye","code_information":[{"code":"72196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri Pelvis W/O Dye","code_information":[{"code":"72195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Ct pelvis w/o & w/dye","code_information":[{"code":"72194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct pelvis w/dye","code_information":[{"code":"72193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct pelvis w/o dye","code_information":[{"code":"72192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ct angiograph pelv w/o&w/dye","code_information":[{"code":"72191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":702.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":656.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":469.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":509.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of pelvis","code_information":[{"code":"72170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Mri lumbar spine w/o & w/dye","code_information":[{"code":"72158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri chest spine w/o & w/dye","code_information":[{"code":"72157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri neck spine w/o & w/dye","code_information":[{"code":"72156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri lumbar spine w/dye","code_information":[{"code":"72149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri lumbar spine w/o dye","code_information":[{"code":"72148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mri chest spine w/dye","code_information":[{"code":"72147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri chest spine w/o dye","code_information":[{"code":"72146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mri neck spine w/dye","code_information":[{"code":"72142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri neck spine w/o dye","code_information":[{"code":"72141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Ct lumbar spine w/o & w/dye","code_information":[{"code":"72133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct lumbar spine w/dye","code_information":[{"code":"72132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Ct lumbar spine w/o dye","code_information":[{"code":"72131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ct chest spine w/o & w/dye","code_information":[{"code":"72130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct chest spine w/dye","code_information":[{"code":"72129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct chest spine w/o dye","code_information":[{"code":"72128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ct neck spine w/o & w/dye","code_information":[{"code":"72127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct neck spine w/dye","code_information":[{"code":"72126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Ct neck spine w/o dye","code_information":[{"code":"72125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray bend only l-s spine","code_information":[{"code":"72120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam l-s spine bending","code_information":[{"code":"72114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam l-2 spine 4/>vws","code_information":[{"code":"72110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam l-s spine 2/3 vws","code_information":[{"code":"72100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of trunk spine","code_information":[{"code":"72090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"X-ray exam thoracolmb 2/> vw","code_information":[{"code":"72080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam thorac spine4/>vw","code_information":[{"code":"72074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam thorac spine 3vws","code_information":[{"code":"72072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam thorac spine 2vws","code_information":[{"code":"72070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of trunk spine","code_information":[{"code":"72069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"X-ray exam neck spine 6/>vws","code_information":[{"code":"72052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam neck spine 4/5vws","code_information":[{"code":"72050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam neck spine 2-3 vw","code_information":[{"code":"72040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of spine 1 view","code_information":[{"code":"72020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of spine","code_information":[{"code":"72010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.17,"maximum":218.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55}]}]},{"description":"Mri chest w/o & w/dye","code_information":[{"code":"71552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri Chest W/Dye","code_information":[{"code":"71551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":685.89,"maximum":1704.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":875.94,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.19,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":777.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":910.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1632.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":859.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1704.7}]}]},{"description":"Mri chest w/o dye","code_information":[{"code":"71550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Ct angiography chest","code_information":[{"code":"71275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":702.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":656.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":469.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":509.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct thorax w/o & w/dye","code_information":[{"code":"71270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct thorax w/dye","code_information":[{"code":"71260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct thorax w/o dye","code_information":[{"code":"71250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray strenoclavic jt 3/>vws","code_information":[{"code":"71130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam breastbone 2/>vws","code_information":[{"code":"71120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam ribs/chest4/> vws","code_information":[{"code":"71111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam ribs bil 3 views","code_information":[{"code":"71110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam unilat ribs/chest","code_information":[{"code":"71101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam ribs uni 2 views","code_information":[{"code":"71100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Chest x-ray special views","code_information":[{"code":"71035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Chest x-ray&fluoro 4/> views","code_information":[{"code":"71034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.96,"maximum":377.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.15},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":251.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":273.32}]}]},{"description":"Chest x-ray 4/> views","code_information":[{"code":"71030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.17,"maximum":218.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55}]}]},{"description":"Chest x-ray and fluoroscopy","code_information":[{"code":"71023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.96,"maximum":377.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.15},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":251.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":273.32}]}]},{"description":"Chest x-ray frnt lat oblique","code_information":[{"code":"71022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Chest x-ray frnt lat lordotc","code_information":[{"code":"71021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Chest x-ray 2vw frontal&latl","code_information":[{"code":"71020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Chest x-ray stereo frontal","code_information":[{"code":"71015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Chest x-ray 1 view frontal","code_information":[{"code":"71010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Mri brain w/o & w/dye","code_information":[{"code":"70559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Mri brain w/dye","code_information":[{"code":"70558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":1026.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Mri brain w/o dye","code_information":[{"code":"70557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":474.07,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Fmri brain by phys/psych","code_information":[{"code":"70555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Fmri brain by tech","code_information":[{"code":"70554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mri brain stem w/o & w/dye","code_information":[{"code":"70553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri brain stem w/dye","code_information":[{"code":"70552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1026.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Mri brain stem w/o dye","code_information":[{"code":"70551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mr angiograph neck w/o&w/dye","code_information":[{"code":"70549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mr Angiography Neck W/Dye","code_information":[{"code":"70548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1026.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Mr Angiography Neck W/O Dye","code_information":[{"code":"70547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mr angiograph head w/o&w/dye","code_information":[{"code":"70546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mr Angiography Head W/Dye","code_information":[{"code":"70545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1026.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Mr Angiography Head W/O Dye","code_information":[{"code":"70544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mri orbt/fac/nck w/o &w/dye","code_information":[{"code":"70543","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1186.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1107.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":792.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1186.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":859.89},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri Orbit/Face/Neck W/Dye","code_information":[{"code":"70542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":958.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":685.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1026.49},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":744.01},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri orbit/face/neck w/o dye","code_information":[{"code":"70540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Ct angiography neck","code_information":[{"code":"70498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":702.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":656.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":469.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":509.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct angiography head","code_information":[{"code":"70496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":702.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":656.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":469.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":702.69},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":509.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct sft tsue nck w/o & w/dye","code_information":[{"code":"70492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct soft tissue neck w/dye","code_information":[{"code":"70491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct soft tissue neck w/o dye","code_information":[{"code":"70490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ct maxillofacial w/o & w/dye","code_information":[{"code":"70488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct maxillofacial w/dye","code_information":[{"code":"70487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct maxillofacial w/o dye","code_information":[{"code":"70486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ct orbit/ear/fossa w/o&w/dye","code_information":[{"code":"70482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct orbit/ear/fossa w/dye","code_information":[{"code":"70481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct orbit/ear/fossa w/o dye","code_information":[{"code":"70480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ct head/brain w/o & w/dye","code_information":[{"code":"70470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":674.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":450.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":674.88},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":489.16},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct head/brain w/dye","code_information":[{"code":"70460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":559.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":400.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.3},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":434.38},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Ct head/brain w/o dye","code_information":[{"code":"70450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":304.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":284.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":203.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220.63},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of salivary duct","code_information":[{"code":"70390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":765.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of salivary gland","code_information":[{"code":"70380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Contrast x-ray of larynx","code_information":[{"code":"70373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":765.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59}]}]},{"description":"Speech evaluation complex","code_information":[{"code":"70371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":251.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":273.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Throat x-ray & fluoroscopy","code_information":[{"code":"70370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":377.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":251.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":377.09},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":273.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of neck","code_information":[{"code":"70360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Panoramic x-ray of jaws","code_information":[{"code":"70355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.56,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":74.37},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray head for orthodontia","code_information":[{"code":"70350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Magnetic image jaw joint","code_information":[{"code":"70336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of jaw joint","code_information":[{"code":"70332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":816.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":545.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":816.72},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":591.96},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of jaw joints","code_information":[{"code":"70330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of jaw joint","code_information":[{"code":"70328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Full mouth x-ray of teeth","code_information":[{"code":"70320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.56,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":74.37},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of teeth","code_information":[{"code":"70310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.56,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":74.37},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of teeth","code_information":[{"code":"70300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.56,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.61},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":74.37},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of skull","code_information":[{"code":"70260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of skull","code_information":[{"code":"70250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam pituitary saddle","code_information":[{"code":"70240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of sinuses","code_information":[{"code":"70220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of sinuses","code_information":[{"code":"70210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of eye sockets","code_information":[{"code":"70200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam of eye sockets","code_information":[{"code":"70190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of tear duct","code_information":[{"code":"70170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":765.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray exam of nasal bones","code_information":[{"code":"70160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo exam of eye","code_information":[{"code":"76529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Us exam of head and neck","code_information":[{"code":"76536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us exam chest","code_information":[{"code":"76604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo exam of breast(s)","code_information":[{"code":"76645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.82,"maximum":216.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1}]}]},{"description":"Us exam abdom complete","code_information":[{"code":"76700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo exam of abdomen","code_information":[{"code":"76705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us exam abdo back wall comp","code_information":[{"code":"76770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us exam abdo back wall lim","code_information":[{"code":"76775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us exam k transpl w/doppler","code_information":[{"code":"76776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us exam spinal canal","code_information":[{"code":"76800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ob us < 14 wks single fetus","code_information":[{"code":"76801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ob us >/= 14 wks sngl fetus","code_information":[{"code":"76805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ob us detailed sngl fetus","code_information":[{"code":"76811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":428.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":306.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":332.92},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ob us nuchal meas 1 gest","code_information":[{"code":"76813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ob us limited fetus(s)","code_information":[{"code":"76815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ob us follow-up per fetus","code_information":[{"code":"76816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Transvaginal us obstetric","code_information":[{"code":"76817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Fetal biophys profile w/nst","code_information":[{"code":"76818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Fetal biophys profil w/o nst","code_information":[{"code":"76819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Umbilical artery echo","code_information":[{"code":"76820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Middle cerebral artery echo","code_information":[{"code":"76821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.13,"maximum":1216.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":563.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":403.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":603.33},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":603.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.33},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":437.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1216.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1216.73}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":603.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":563.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":403.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":603.33},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":603.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":603.33},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":437.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo exam of fetal heart","code_information":[{"code":"76828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-Ray Stress View","code_information":[{"code":"77071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-Rays for Bone Age","code_information":[{"code":"77072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-rays bone length studies","code_information":[{"code":"77073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-rays bone survey limited","code_information":[{"code":"77074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-rays bone survey complete","code_information":[{"code":"77075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-rays bone survey infant","code_information":[{"code":"77076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":204.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":146.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":218.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":158.55},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Joint survey single view","code_information":[{"code":"77077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ct bone density axial","code_information":[{"code":"77078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":217.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":145.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":217.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":217.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.0},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.29},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Dxa bone density axial","code_information":[{"code":"77080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":145.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":217.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":217.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.0},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.29},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Dxa bone density/peripheral","code_information":[{"code":"77081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.36,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":82.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":123.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":123.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.26},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":89.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"DXA Bone Density, Vert Fx","code_information":[{"code":"77082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.23,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.03},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100.04}]}]},{"description":"Magnetic image bone marrow","code_information":[{"code":"77084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":709.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":662.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":474.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":514.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Thyroid uptake measurement","code_information":[{"code":"78012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.78,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":315.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":225.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":337.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":337.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":337.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":244.9},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.95,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":412.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":294.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":441.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":441.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":441.42},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":319.95},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Thyroid imaging w/blood flow","code_information":[{"code":"78014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":644.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":461.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":690.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":690.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.61},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":500.56},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Thyroid met imaging","code_information":[{"code":"78015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":921.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":860.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":615.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":667.74},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Thyroid met imaging/studies","code_information":[{"code":"78016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":921.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":860.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":615.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":667.74},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Thyroid met imaging body","code_information":[{"code":"78018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":860.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":615.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":667.74},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Parathyroid planar imaging","code_information":[{"code":"78070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":644.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":461.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":690.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":690.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":690.61},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":500.56},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Parathyrd planar w/wo subtrj","code_information":[{"code":"78071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1777.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Parathyrd planar w/spect&ct","code_information":[{"code":"78072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1777.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Adrenal cortex & medulla img","code_information":[{"code":"78075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2601.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1861.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2019.11},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Endocrine nuclear procedure","code_information":[{"code":"78099","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":294.95,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":412.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":294.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":441.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":441.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":441.42},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":319.95},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Bone marrow imaging ltd","code_information":[{"code":"78102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":778.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":556.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":604.19},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Bone marrow imaging mult","code_information":[{"code":"78103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":778.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":556.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":604.19},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Bone marrow imaging body","code_information":[{"code":"78104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":778.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":556.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":604.19},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Gastroesophageal reflux exam","code_information":[{"code":"78262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Vit B-12 absorption exam","code_information":[{"code":"78270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":414.0,"maximum":619.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.64},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.09}]}]},{"description":"Vit b-12 absrp exam int fac","code_information":[{"code":"78271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":414.0,"maximum":619.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.64},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.09}]}]},{"description":"Vit b-12 absorp combined","code_information":[{"code":"78272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":414.0,"maximum":619.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.64},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.09}]}]},{"description":"Acute GI blood loss imaging","code_information":[{"code":"78278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"GI protein loss exam","code_information":[{"code":"78282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Meckels divert exam","code_information":[{"code":"78290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Leveen/shunt patency exam","code_information":[{"code":"78291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"GI nuclear procedure","code_information":[{"code":"78299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Bone imaging limited area","code_information":[{"code":"78300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":728.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":565.11},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Bone imaging multiple areas","code_information":[{"code":"78305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":728.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":565.11},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Bone imaging whole body","code_information":[{"code":"78306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":728.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":565.11},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Bone imaging 3 phase","code_information":[{"code":"78315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":728.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":565.11},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Bone imaging (3D)","code_information":[{"code":"78320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":520.97,"maximum":779.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":728.14},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":565.11}]}]},{"description":"Musculoskeletal nuclear exam","code_information":[{"code":"78399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":728.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.66},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":565.11},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Non-imaging heart function","code_information":[{"code":"78414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Cardiac shunt imaging","code_information":[{"code":"78428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":922.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Vascular flow imaging","code_information":[{"code":"78445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Ht muscle image spect sing","code_information":[{"code":"78451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2593.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1855.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2012.47},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Ht muscle image spect mult","code_information":[{"code":"78452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2593.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1855.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2012.47},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Ht muscle image planar sing","code_information":[{"code":"78453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2593.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1855.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2012.47},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Ht musc image planar mult","code_information":[{"code":"78454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2593.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1855.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2012.47},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Acute venous thrombus image","code_information":[{"code":"78456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.98,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1660.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1187.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1777.9},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1288.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Venous thrombosis imaging","code_information":[{"code":"78457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":511.27,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Ven thrombosis images bilat","code_information":[{"code":"78458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.15},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.59},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Heart muscle imaging (PET)","code_information":[{"code":"78459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3154.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Heart infarct image","code_information":[{"code":"78466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":922.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Heart infarct image (ef)","code_information":[{"code":"78468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Heart infarct image (3D)","code_information":[{"code":"78469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Gated heart planar single","code_information":[{"code":"78472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":922.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Gated heart multiple","code_information":[{"code":"78473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":922.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Heart first pass single","code_information":[{"code":"78481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Heart first pass multiple","code_information":[{"code":"78483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":2776.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2593.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1855.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2776.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2012.47},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Heart image (pet) single","code_information":[{"code":"78491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3443.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05}]}]},{"description":"Heart image (pet) multiple","code_information":[{"code":"78492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3443.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05}]}]},{"description":"Heart image spect","code_information":[{"code":"78494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":922.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Cardiovascular nuclear exam","code_information":[{"code":"78499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":922.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":861.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":616.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.06},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":668.32},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Lung ventilation imaging","code_information":[{"code":"78579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":492.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":533.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Lung perfusion imaging","code_information":[{"code":"78580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":492.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":533.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Lung ventilat&perfus imaging","code_information":[{"code":"78582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":968.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":692.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1037.04},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1037.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1037.04},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":751.65},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Lung perfusion differential","code_information":[{"code":"78597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":492.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":533.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Lung perf&ventilat diferentl","code_information":[{"code":"78598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":968.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":692.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1037.04},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1037.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1037.04},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":751.65},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Respiratory nuclear exam","code_information":[{"code":"78599","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":492.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":736.51},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":533.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Brain image < 4 views","code_information":[{"code":"78600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.63,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":365.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":261.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":283.8},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Brain image w/flow < 4 views","code_information":[{"code":"78601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1283.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Brain image 4+ views","code_information":[{"code":"78605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1283.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Brain image w/flow 4 + views","code_information":[{"code":"78606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1283.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Brain imaging (3D)","code_information":[{"code":"78607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1861.39,"maximum":2785.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2601.59},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1861.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2019.11}]}]},{"description":"Brain imaging (PET)","code_information":[{"code":"78608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3443.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05}]}]},{"description":"Brain flow imaging only","code_information":[{"code":"78610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1283.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Cerebrospinal fluid scan","code_information":[{"code":"78630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1283.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Pet image skull-thigh","code_information":[{"code":"78812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3443.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05}]}]},{"description":"Pet image full body","code_information":[{"code":"78813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3443.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05}]}]},{"description":"Pet image w/ct lmtd","code_information":[{"code":"78814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3443.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05}]}]},{"description":"Pet image w/ct skull-thigh","code_information":[{"code":"78815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3443.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05}]}]},{"description":"Pet image w/ct full body","code_information":[{"code":"78816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3443.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3443.05}]}]},{"description":"Nuclear diagnostic exam","code_information":[{"code":"78999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":225.78,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":315.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":225.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":337.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":337.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":337.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":244.9},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Nuclear rx oral admin","code_information":[{"code":"79005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.48,"maximum":615.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":411.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":446.27},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":485.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":596.2}]}]},{"description":"Nuclear rx iv admin","code_information":[{"code":"79101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.48,"maximum":615.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":411.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":446.27},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":485.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":596.2}]}]},{"description":"Nuclear rx intracav admin","code_information":[{"code":"79200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.48,"maximum":858.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":801.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":573.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":622.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":485.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":596.2}]}]},{"description":"Nuclr rx interstit colloid","code_information":[{"code":"79300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.48,"maximum":615.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":411.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":446.27},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":485.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":596.2}]}]},{"description":"Hematopoietic nuclear tx","code_information":[{"code":"79403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.48,"maximum":858.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":801.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":573.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":622.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":485.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":596.2}]}]},{"description":"Nuclear rx intra-articular","code_information":[{"code":"79440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.48,"maximum":858.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":801.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":573.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":858.48},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":622.24},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":485.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":596.2}]}]},{"description":"Nuclear rx intra-arterial","code_information":[{"code":"79445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.48,"maximum":615.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":411.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":446.27},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":485.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":596.2}]}]},{"description":"Nuclear medicine therapy","code_information":[{"code":"79999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":231.48,"maximum":615.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.72,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":411.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.98,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":615.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":446.27},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":485.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":596.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":596.2}]}]},{"description":"Scr mammo bi incl cad","code_information":[{"code":"G0202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.45,"maximum":246.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":229.85},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":164.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":246.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":246.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":246.13},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":178.4}]}]},{"description":"Dx mammo incl cad bi","code_information":[{"code":"G0204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.7,"maximum":297.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.72},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":198.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":297.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":297.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.37},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":215.54}]}]},{"description":"Dx mammo incl cad uni","code_information":[{"code":"G0206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.59,"maximum":232.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.47},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":155.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":232.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":232.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":232.86},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":168.78}]}]},{"description":"Transvaginal us non-ob","code_information":[{"code":"76830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo exam uterus","code_information":[{"code":"76831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":428.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":306.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":332.92},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Us exam pelvic complete","code_information":[{"code":"76856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us exam pelvic limited","code_information":[{"code":"76857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us exam scrotum","code_information":[{"code":"76870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us transrectal","code_information":[{"code":"76872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echograp trans r pros study","code_information":[{"code":"76873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":459.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":428.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":306.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":332.92},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us xtr non-vasc complete","code_information":[{"code":"76881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":323.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":216.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.89},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":234.76},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us xtr non-vasc lmtd","code_information":[{"code":"76882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Us exam infant hips dynamic","code_information":[{"code":"76885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":216.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Us exam infant hips static","code_information":[{"code":"76886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":216.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Echo guide for artery repair","code_information":[{"code":"76936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":210.77,"maximum":622.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":210.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":315.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":315.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":315.44},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":228.64},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":622.08},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":622.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":622.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":622.08}]}]},{"description":"Ultrasound exam follow-up","code_information":[{"code":"76970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":144.82,"maximum":216.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1}]}]},{"description":"GI endoscopic ultrasound","code_information":[{"code":"76975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":428.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":306.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":459.32},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":332.92},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Us bone density measure","code_information":[{"code":"76977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":85.94,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":85.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":128.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":128.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.62},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":93.23},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Echo examination procedure","code_information":[{"code":"76999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":216.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.75},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":157.1},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Computer Dx Mammogram Add-on","code_information":[{"code":"77051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":18.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.92},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13.13}]}]},{"description":"Computer Screening Mammogram Add-on","code_information":[{"code":"77052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":18.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.92},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":12.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.12},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13.13}]}]},{"description":"X-Ray of Mammary Duct","code_information":[{"code":"77053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":765.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.17},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"X-ray of mammary ducts","code_information":[{"code":"77054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":765.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":714.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":511.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":765.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":765.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":765.17},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":554.6},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mammogram, One Breast","code_information":[{"code":"77055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.05,"maximum":134.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125.86},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":90.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":134.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":134.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134.76},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":97.67}]}]},{"description":"Mammogram, Both Breasts","code_information":[{"code":"77056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.38,"maximum":177.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":165.46},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":118.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":177.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":177.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.18},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":128.42}]}]},{"description":"Mammogram, Screening","code_information":[{"code":"77057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.65,"maximum":116.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108.53},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":77.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":116.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":116.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.22},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":84.24}]}]},{"description":"Dx mammo incl cad uni","code_information":[{"code":"77065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.59,"maximum":240.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.47},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":155.59},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":240.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.3},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":240.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":240.3}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":83.18,"maximum":174.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":174.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91.94,"additional_payer_notes":"APC"}]}]},{"description":"Dx mammo incl cad bi","code_information":[{"code":"77066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.7,"maximum":306.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.72},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":198.7},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":306.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":306.9},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":306.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":306.9}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":106.90,"maximum":224.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":224.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118.16,"additional_payer_notes":"APC"}]}]},{"description":"Scr mammo bi incl cad","code_information":[{"code":"77067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.45,"maximum":253.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":229.85},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":164.45},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":253.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":253.8},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":253.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":253.8}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":82.99,"maximum":174.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":174.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91.73,"additional_payer_notes":"APC"}]}]},{"description":"Plasma volume single","code_information":[{"code":"78110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":910.17,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1272.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":987.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Plasma volume multiple","code_information":[{"code":"78111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":910.17,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1272.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":987.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Red cell mass single","code_information":[{"code":"78120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1362.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1272.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":987.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Red cell mass multiple","code_information":[{"code":"78121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1362.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1272.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":987.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Blood volume","code_information":[{"code":"78122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1362.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1272.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":987.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Red cell survival study","code_information":[{"code":"78130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1362.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1272.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":987.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Red cell survival kinetics","code_information":[{"code":"78135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":910.17,"maximum":1362.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1272.11},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":987.3}]}]},{"description":"Red cell sequestration","code_information":[{"code":"78140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1362.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1272.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":910.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1362.16},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":987.3},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Spleen imaging","code_information":[{"code":"78185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":778.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":556.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":604.19},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Platelet survival kinetics","code_information":[{"code":"78190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":414.0,"maximum":619.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.64},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.09}]}]},{"description":"Platelet survival","code_information":[{"code":"78191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.09},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Lymph system imaging","code_information":[{"code":"78195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":778.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":556.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":604.19},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Blood/lymph nuclear exam","code_information":[{"code":"78199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":778.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":556.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":833.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":604.19},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Liver imaging","code_information":[{"code":"78201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":599.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":649.94},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Liver imaging with flow","code_information":[{"code":"78202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":599.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":649.94},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Liver imaging (3D)","code_information":[{"code":"78205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.17,"maximum":896.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.44},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":599.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":649.94}]}]},{"description":"Liver image (3d) with flow","code_information":[{"code":"78206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":599.17,"maximum":896.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.44},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":599.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":649.94}]}]},{"description":"Liver and spleen imaging","code_information":[{"code":"78215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":896.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":599.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":649.94},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Liver & spleen image/flow","code_information":[{"code":"78216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":896.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":599.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":649.94},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Hepatobiliary system imaging","code_information":[{"code":"78226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":896.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":599.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":649.94},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Hepatobil syst image w/drug","code_information":[{"code":"78227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":599.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":649.94},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Salivary gland imaging","code_information":[{"code":"78230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Serial salivary imaging","code_information":[{"code":"78231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Salivary gland function exam","code_information":[{"code":"78232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Esophageal motility study","code_information":[{"code":"78258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Gastric mucosa imaging","code_information":[{"code":"78261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":520.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.28},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":564.83},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"CSF ventriculography","code_information":[{"code":"78635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1283.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"CSF shunt evaluation","code_information":[{"code":"78645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1283.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Cerebrospinal fluid scan","code_information":[{"code":"78647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":857.47,"maximum":1283.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13}]}]},{"description":"CSF leakage imaging","code_information":[{"code":"78650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":857.47,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1198.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":857.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1283.27},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":930.13},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Nuclear exam of tear flow","code_information":[{"code":"78660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.63,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":365.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":261.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":283.8},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Nervous system nuclear exam","code_information":[{"code":"78699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.63,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":365.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":261.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":391.55},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":283.8},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Kidney imaging morphol","code_information":[{"code":"78700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1003.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Kidney imaging with flow","code_information":[{"code":"78701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1003.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"K flow/funct image w/o drug","code_information":[{"code":"78707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"K flow/funct image w/drug","code_information":[{"code":"78708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"K flow/funct image multiple","code_information":[{"code":"78709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Kidney imaging (3D)","code_information":[{"code":"78710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.66,"maximum":1003.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49}]}]},{"description":"Kidney function study","code_information":[{"code":"78725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.09},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Ureteral reflux study","code_information":[{"code":"78740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1003.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Testicular imaging w/flow","code_information":[{"code":"78761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1003.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Genitourinary nuclear exam","code_information":[{"code":"78799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":1003.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":937.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":670.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1003.7},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":727.49},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Tumor imaging limited area","code_information":[{"code":"78800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":921.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":860.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":615.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":667.74},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Tumor imaging mult areas","code_information":[{"code":"78801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":921.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":860.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":615.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":921.26},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":667.74},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Tumor imaging whole body","code_information":[{"code":"78802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1476.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1056.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1146.08},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Tumor imaging (3D)","code_information":[{"code":"78803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1581.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1476.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1056.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1146.08},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Tumor imaging whole body","code_information":[{"code":"78804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":3006.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2601.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1861.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2785.71},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2019.11},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Abscess imaging ltd area","code_information":[{"code":"78805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1056.55,"maximum":1581.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1476.7},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1056.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1146.08}]}]},{"description":"Abscess imaging whole body","code_information":[{"code":"78806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1056.55,"maximum":1581.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1476.7},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1056.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1146.08}]}]},{"description":"Nuclear localization/abscess","code_information":[{"code":"78807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1056.55,"maximum":1581.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1476.7},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1056.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1581.21},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":1146.08}]}]},{"description":"Iv inj ra drug dx study","code_information":[{"code":"78808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":414.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":619.59},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":449.09},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Pet image ltd area","code_information":[{"code":"78811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3154.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":2107.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3154.39},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":2286.34},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3006.7}]}]},{"description":"Ct colonography screening","code_information":[{"code":"74263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":1650.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1650.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1650.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1650.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1650.58}]}]},{"description":"X-ray xm esophagus 2cntrst","code_information":[{"code":"74221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":455.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":455.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":455.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":455.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":455.5}]}]},{"description":"Mri angio abdom w orw/o dye","code_information":[{"code":"74185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":799.2,"maximum":799.2,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":799.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":799.2},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":799.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":799.2}]}]},{"description":"X-ray exam abdomen 3+ views","code_information":[{"code":"74021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam abdomen 2 views","code_information":[{"code":"74019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam abdomen 1 view","code_information":[{"code":"74018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Mr ang lwr ext w or w/o dye","code_information":[{"code":"73725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":792.0,"maximum":792.0,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":792.0},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":792.0},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":792.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":792.0}]}]},{"description":"X-ray exam of femur 2/>","code_information":[{"code":"73552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam of femur 1","code_information":[{"code":"73551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam hips bi 5/> views","code_information":[{"code":"73523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam hips bi 3-4 views","code_information":[{"code":"73522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam hips bi 2 views","code_information":[{"code":"73521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam hip uni 4/> views","code_information":[{"code":"73503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam hip uni 2-3 views","code_information":[{"code":"73502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam hip uni 1 view","code_information":[{"code":"73501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Mr angio upr extr w/o&w/dye","code_information":[{"code":"73225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":820.8,"maximum":820.8,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":820.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":820.8},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":820.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":820.8}]}]},{"description":"Mr angio pelvis w/o & w/dye","code_information":[{"code":"72198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":793.8,"maximum":793.8,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":793.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":793.8},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":793.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":793.8}]}]},{"description":"Mr angio spine w/o&w/dye","code_information":[{"code":"72159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":811.8,"maximum":811.8,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":811.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":811.8},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":811.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":811.8}]}]},{"description":"X-ray exam entire spi 6/> vw","code_information":[{"code":"72084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam entire spi 4/5 vw","code_information":[{"code":"72083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam entire spi 2/3 vw","code_information":[{"code":"72082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam entire spi 1 vw","code_information":[{"code":"72081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Mri angio chest w or w/o dye","code_information":[{"code":"71555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":789.3,"maximum":789.3,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":789.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":789.3},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":789.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":789.3}]}]},{"description":"Ct thorax lung cancer scr c-","code_information":[{"code":"71271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":202.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":202.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":202.25}]}]},{"description":"X-ray exam chest 4+ views","code_information":[{"code":"71048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"X-ray exam chest 3 views","code_information":[{"code":"71047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam chest 2 views","code_information":[{"code":"71046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"X-ray exam chest 1 view","code_information":[{"code":"71045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Ortho impl mvmt alys pair ct","code_information":[{"code":"0946T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":265.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":265.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":265.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":265.85}]}]},{"description":"3d cntr simula trgt lvr les","code_information":[{"code":"0944T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":604.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":604.3}]}]},{"description":"Histotripsy mal renal tissue","code_information":[{"code":"0888T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16993.56,"maximum":43751.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19140.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18424.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16993.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17887.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18603.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19891.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35673.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18961.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43751.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43751.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18782.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43751.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43751.25}]}]},{"description":"Quan mri alys brn w/dx mri","code_information":[{"code":"0866T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":583.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":583.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":583.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":583.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":583.68}]}]},{"description":"Quan mri alys brn w/o dx mri","code_information":[{"code":"0865T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":583.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":583.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":583.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":583.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":583.68}]}]},{"description":"Opto-acoustic img breast uni","code_information":[{"code":"0857T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":261.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":261.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":261.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":261.88}]}]},{"description":"Pulm tiss vntj alys w/ct","code_information":[{"code":"0808T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":700.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":700.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":700.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":700.15}]}]},{"description":"Pulm tiss vntj alys prev ct","code_information":[{"code":"0807T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":363.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":363.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":363.58}]}]},{"description":"Smmg cncrnt appl imu snr","code_information":[{"code":"0778T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":363.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":363.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":363.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":363.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":363.58}]}]},{"description":"B1 str & fx rsk vrt fx assmt","code_information":[{"code":"0743T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":604.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":604.3}]}]},{"description":"Qmrcp w/o dx mri sm anat ses","code_information":[{"code":"0723T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.97,"maximum":2376.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1010.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1080.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1937.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2376.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2376.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1020.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2376.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2376.25}]}]},{"description":"Quan ct tiss charac w/o ct","code_information":[{"code":"0721T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":631.66,"maximum":1626.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":711.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":684.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":631.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":664.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":691.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1326.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":704.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1626.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1626.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":698.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1626.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1626.25}]}]},{"description":"Molec fluor img sus nev ea","code_information":[{"code":"0701T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.28,"maximum":26.28,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.28},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26.28}]}]},{"description":"Molec fluor img sus nev 1st","code_information":[{"code":"0700T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.95,"maximum":88.95,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":88.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88.95},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":88.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":88.95}]}]},{"description":"Quan mr tis wo mri mlt orgn","code_information":[{"code":"0697T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":587.5,"maximum":1937.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1010.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1080.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1937.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":587.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":587.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1020.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":587.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":587.5}]}]},{"description":"Compre ful bdy 3d mtn alys","code_information":[{"code":"0693T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":340.35,"maximum":876.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":383.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":369.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":340.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":372.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":398.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":714.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":379.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":876.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":876.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":376.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":876.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":876.25}]}]},{"description":"Auto alys xst ct std vrt fx","code_information":[{"code":"0691T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.18,"maximum":21.18,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21.18},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.18},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21.18}]}]},{"description":"Quan us tis charac w/o dx us","code_information":[{"code":"0689T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":206.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":206.53}]}]},{"description":"Histotripsy mal hepatcel tis","code_information":[{"code":"0686T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31251.25,"maximum":71346.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38279.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36848.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33986.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35775.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37206.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39782.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":71346.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37921.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31251.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31251.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37564.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31251.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31251.25}]}]},{"description":"Elec impd spectrsc 1+skn les","code_information":[{"code":"0658T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":139.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":139.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":139.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":139.15}]}]},{"description":"Quan mr alys tiss w/o mri","code_information":[{"code":"0648T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":575.33,"maximum":1937.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1010.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1080.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1937.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1020.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":575.33}]}]},{"description":"Wrls skn snr anisotropy meas","code_information":[{"code":"0639T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":210.23,"maximum":210.23,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":210.23},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.23},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":210.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":210.23}]}]},{"description":"Ct breast w/3d bi c-/c+","code_information":[{"code":"0638T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":920.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":920.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":920.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":920.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":920.3}]}]},{"description":"Ct breast w/3d bi c+","code_information":[{"code":"0637T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":920.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":920.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":920.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":920.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":920.3}]}]},{"description":"Ct breast w/3d bi c-","code_information":[{"code":"0636T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":575.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":575.33}]}]},{"description":"Ct breast w/3d uni c-/c+","code_information":[{"code":"0635T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":446.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":446.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":446.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":446.38}]}]},{"description":"Ct breast w/3d uni c+","code_information":[{"code":"0634T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":446.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":446.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":446.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":446.38}]}]},{"description":"Ct breast w/3d uni c-","code_information":[{"code":"0633T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":272.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":272.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":272.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":272.43}]}]},{"description":"Mrs discogenic pain i&r","code_information":[{"code":"0612T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.65,"maximum":70.65,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.65},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":70.65}]}]},{"description":"Mrs disc pain alg alys data","code_information":[{"code":"0611T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":575.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":575.33}]}]},{"description":"Mrs disc pain transmis data","code_information":[{"code":"0610T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":429.18,"maximum":429.18,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":429.18},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":429.18},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":429.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":429.18}]}]},{"description":"Mrs disc pain acquisj data","code_information":[{"code":"0609T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":575.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":575.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":575.33}]}]},{"description":"Rem oct rta phys/qhp ea 30d","code_information":[{"code":"0606T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.4,"maximum":72.4,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":72.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72.4},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":72.4}]}]},{"description":"Rem oct rta techl sprt min 8","code_information":[{"code":"0605T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.63,"maximum":90.63,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90.63},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":90.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":90.63}]}]},{"description":"Rem oct rta dev setup&educaj","code_information":[{"code":"0604T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":289.83,"maximum":289.83,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":289.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":289.83},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":289.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":289.83}]}]},{"description":"Transdermal gfr monitoring","code_information":[{"code":"0603T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1270.1,"maximum":1270.1,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1270.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1270.1},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1270.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1270.1}]}]},{"description":"Transdermal gfr measurements","code_information":[{"code":"0602T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":503.33,"maximum":503.33,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":503.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":503.33},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":503.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":503.33}]}]},{"description":"Ncntc r-t fluor wnd img 1st","code_information":[{"code":"0598T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":632.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":632.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":632.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":632.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":632.75}]}]},{"description":"Antmc guide 3d print 1st gd","code_information":[{"code":"0561T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":139.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":139.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":139.75}]}]},{"description":"Antmc mdl 3d print 1st cmpnt","code_information":[{"code":"0559T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":139.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":139.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":139.75}]}]},{"description":"Ct scan f/biomchn ct alys","code_information":[{"code":"0558T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.75}]}]},{"description":"B1 str & fx rsk i&r","code_information":[{"code":"0557T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.35,"maximum":24.35,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24.35},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.35},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24.35}]}]},{"description":"B1 str & fx rsk assessment","code_information":[{"code":"0556T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":576.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":576.4}]}]},{"description":"B1 str&fx rsk transmis data","code_information":[{"code":"0555T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.69,"maximum":60.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42.93}]}]},{"description":"B1 str & fx rsk analysis","code_information":[{"code":"0554T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.45,"maximum":97.45,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":97.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.45},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":97.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":97.45}]}]},{"description":"B1 matrl qual tst mcrind tib","code_information":[{"code":"0547T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":657.73,"maximum":657.73,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":657.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":657.73},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":657.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":657.73}]}]},{"description":"Tactile breast img uni/bi","code_information":[{"code":"0422T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Mri fetal sngl/1st gestation","code_information":[{"code":"74712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"N-invas est c ffr sw aly cta","code_information":[{"code":"75580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":2490.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2490.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2490.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2490.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2490.45}]}]},{"description":"Mr sfty implt&/fb asmt stf 1","code_information":[{"code":"76014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.69,"maximum":61.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61.23},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":61.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":61.23}]}]},{"description":"Mr safety deter phys/qhp","code_information":[{"code":"76016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":220.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":220.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":220.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":220.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":220.13}]}]},{"description":"Mr sfty med physics xm cstmz","code_information":[{"code":"76017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":604.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":604.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":604.3}]}]},{"description":"Mr safety implant elec prepj","code_information":[{"code":"76018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.32,"maximum":229.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":198.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":229.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":229.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":229.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":229.48}]}]},{"description":"Mr safety implt pos&/immoblj","code_information":[{"code":"76019","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":148.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":148.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":148.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":148.5}]}]},{"description":"Us nrv&acc strux 1xtr compre","code_information":[{"code":"76883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":267.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":267.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":267.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":267.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":267.2}]}]},{"description":"Us trgt dyn mbubb 1st les","code_information":[{"code":"76978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":504.35},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":504.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":504.35},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":504.35}]}]},{"description":"Use parenchyma","code_information":[{"code":"76981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":281.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":281.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":281.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":281.28}]}]},{"description":"Use 1st target lesion","code_information":[{"code":"76982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":281.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":281.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":281.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":281.28}]}]},{"description":"Mri breast c- unilateral","code_information":[{"code":"77046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":576.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":576.4}]}]},{"description":"Mri breast c- bilateral","code_information":[{"code":"77047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":576.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":576.4}]}]},{"description":"Mri breast c-+ w/cad uni","code_information":[{"code":"77048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":736.1,"maximum":736.1,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":736.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":736.1},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":736.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":736.1}]}]},{"description":"Mri breast c-+ w/cad bi","code_information":[{"code":"77049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":732.5,"maximum":732.5,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":732.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":732.5},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":732.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":732.5}]}]},{"description":"Breast tomosynthesis uni","code_information":[{"code":"77061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":235.15,"maximum":235.15,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":235.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":235.15},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":235.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":235.15}]}]},{"description":"Breast tomosynthesis bi","code_information":[{"code":"77062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":300.93,"maximum":300.93,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":300.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":300.93},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":300.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":300.93}]}]},{"description":"Breast tomosynthesis bi","code_information":[{"code":"77063","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.9,"maximum":63.9,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.9},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":63.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63.9}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":22.50,"maximum":47.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.86,"additional_payer_notes":"APC"}]}]},{"description":"Oct breast surg cavity i&r","code_information":[{"code":"0354T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2428.55,"maximum":2428.55,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2428.55},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2428.55},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2428.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2428.55}]}]},{"description":"Oct brst/node i&r per spec","code_information":[{"code":"0352T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2428.55,"maximum":2428.55,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":2428.55},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2428.55},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":2428.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":2428.55}]}]},{"description":"RSA lower extr exam","code_information":[{"code":"0350T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"RSA upper extr exam","code_information":[{"code":"0349T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"RSA spine exam","code_information":[{"code":"0348T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Med physic dos eval rad exps","code_information":[{"code":"76145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":317.18,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":317.18},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":317.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":317.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":317.18}]}]},{"description":"Mr spectroscopy","code_information":[{"code":"76390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":965.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":965.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":965.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":965.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":965.7}]}]},{"description":"Mr elastography","code_information":[{"code":"76391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":576.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":576.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":576.4}]}]},{"description":"Ultrasound breast complete","code_information":[{"code":"76641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Ultrasound breast limited","code_information":[{"code":"76642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Us abdl aorta screen aaa","code_information":[{"code":"76706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Dxa bone density study","code_information":[{"code":"77085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"Fracture assessment via dxa","code_information":[{"code":"77086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":155.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155.3}]}]},{"description":"Tbs dxa cal w/i&r fx risk","code_information":[{"code":"77089","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.83,"maximum":103.83,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":103.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.83},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":103.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":103.83}]}]},{"description":"Tbs techl prep&transmis data","code_information":[{"code":"77090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":206.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":206.53}]}]},{"description":"Tbs techl calculation only","code_information":[{"code":"77091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":206.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":206.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":206.53}]}]},{"description":"Tbs i&r fx rsk qhp","code_information":[{"code":"77092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.95,"maximum":25.95,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.95},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25.95}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":873.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":873.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":873.6}]}]},{"description":"Gastric emptying imag study","code_information":[{"code":"78266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":538.66,"maximum":1132.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":606.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":538.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":567.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":589.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":630.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1130.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1132.7}]}]},{"description":"Breath tst attain/anal c-14","code_information":[{"code":"78267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.51,"maximum":27.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27.65}]}]},{"description":"Breath test analysis c-14","code_information":[{"code":"78268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":89.69,"maximum":236.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":188.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":236.03},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":236.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":236.03}]}]},{"description":"Bone mineral single photon","code_information":[{"code":"78350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":56.7,"maximum":56.7,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.7},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":56.7}]}]},{"description":"Bone mineral dual photon","code_information":[{"code":"78351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.6,"maximum":39.6,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.6},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39.6}]}]},{"description":"Myocrd img pet 1 std w/ct","code_information":[{"code":"78429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3607.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3607.5}]}]},{"description":"Myocrd img pet rst/strs w/ct","code_information":[{"code":"78430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3607.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3607.5}]}]},{"description":"Myocrd img pet rst&strs ct","code_information":[{"code":"78431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2185.31,"maximum":5626.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2461.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2369.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2185.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2300.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2392.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2557.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4587.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":5626.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5626.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2415.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":5626.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":5626.25}]}]},{"description":"Myocrd img pet 2rtracer","code_information":[{"code":"78432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1505.59,"maximum":6876.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1695.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1632.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1505.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1584.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1648.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1762.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3160.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6876.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6876.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1664.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6876.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6876.25}]}]},{"description":"Myocrd img pet 2rtracer ct","code_information":[{"code":"78433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2185.31,"maximum":6876.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2461.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2369.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2185.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2300.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2392.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2557.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4587.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":6876.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6876.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2415.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":6876.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":6876.25}]}]},{"description":"Rp loclzj tum spect w/ct 1","code_information":[{"code":"78830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3180.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3180.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3180.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3180.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3180.13}]}]},{"description":"Rp loclzj tum spect 2 areas","code_information":[{"code":"78831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.38,"maximum":3180.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1351.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3180.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3180.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3180.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3180.13}]}]},{"description":"Rp loclzj tum spect w/ct 2","code_information":[{"code":"78832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1418.60,"maximum":3607.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1597.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1538.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1418.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1493.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1553.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1660.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2978.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1582.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1567.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3607.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3607.5}]}]},{"description":"Liver elastography","code_information":[{"code":"91200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":345.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":345.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":345.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":345.88}]}]},{"description":"Cptrz oph img pst sg rta oct","code_information":[{"code":"92137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":778.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":778.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":778.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":778.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":778.5}]}]},{"description":"3d anat seg imaging preop","code_information":[{"code":"C8001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":220.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":220.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":220.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":220.13}]}]},{"description":"Mra w/cont, abd","code_information":[{"code":"C8900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Mra w/o cont, abd","code_information":[{"code":"C8901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mra w/o fol w/cont, abd","code_information":[{"code":"C8902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri w/cont, breast,  uni","code_information":[{"code":"C8903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Mri w/o fol w/cont, brst, un","code_information":[{"code":"C8905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri w/cont, breast,  bi","code_information":[{"code":"C8906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mri w/o fol w/cont, breast,","code_information":[{"code":"C8908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"MRA w/cont, chest","code_information":[{"code":"C8909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"MRA w/o cont, chest","code_information":[{"code":"C8910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"MRA w/o fol w/cont, chest","code_information":[{"code":"C8911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mra w/cont, lwr ext","code_information":[{"code":"C8912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"Mra w/o cont, lwr ext","code_information":[{"code":"C8913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mra w/o fol w/cont, lwr ext","code_information":[{"code":"C8914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"MRA w/cont, pelvis","code_information":[{"code":"C8918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"MRA w/o cont, pelvis","code_information":[{"code":"C8919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Mra w/o fol w/cont, pelvis","code_information":[{"code":"C8920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"MRA, w/dye, spinal canal","code_information":[{"code":"C8931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":1140.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1140.93}]}]},{"description":"MRA, w/o dye, spinal canal","code_information":[{"code":"C8932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"MRA, w/o&w/dye, spinal canal","code_information":[{"code":"C8933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"MRA, w/dye, upper extremity","code_information":[{"code":"C8934","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"MRA, w/o dye, upper extr","code_information":[{"code":"C8935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":580.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"MRA, w/o&w/dye, upper extr","code_information":[{"code":"C8936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":631.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":631.85}]}]},{"description":"Non-ophthalmic FVA","code_information":[{"code":"C9733","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":580.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":580.78}]}]},{"description":"Cardiac MRI seg dys strain","code_information":[{"code":"C9762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1203.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1203.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1203.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1203.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1203.95}]}]},{"description":"Cardiac MRI seg dys stress","code_information":[{"code":"C9763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1203.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":1203.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1203.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":1203.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":1203.95}]}]},{"description":"Mri hyperpolarized xenon129","code_information":[{"code":"C9791","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1214.28,"maximum":3126.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1367.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1316.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1214.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1278.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1329.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1421.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2549.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1354.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3126.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3126.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1342.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":3126.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3126.25}]}]},{"description":"Single energy x-ray study","code_information":[{"code":"G0130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":286.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":286.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":286.15}]}]},{"description":"PET not otherwise specified","code_information":[{"code":"G0235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":396.60,"maximum":942.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":446.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":430.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":832.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":942.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":942.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":942.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":942.8}]}]},{"description":"Tomosynthesis, mammo","code_information":[{"code":"G0279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.9,"maximum":63.9,"payers_information":[{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.9},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":63.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63.9}]},{"setting":"outpatient","billing_class":"facility","modifier_code":["TC"],"minimum":12.22,"maximum":25.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"}]}]},{"description":"3d bn img algor drvd fr mri","code_information":[{"code":"G0566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":391.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":391.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":391.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":391.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":391.15}]}]},{"description":"Other Cerebrovascular Disorders With Cc","code_information":[{"code":"071","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8991.94,"maximum":42854.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15189.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27125.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9621.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25769.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17856.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27063.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17877.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19075.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9261.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9261.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16447.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30674.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42854.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18662.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22704.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24153.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9621.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17506.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9621.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9261.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22444.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9621.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18927.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8991.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9351.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9999.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11869.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9621.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17750.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9531.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8991.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20271.71},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24628.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9441.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22959.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20271.71},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8991.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9621.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With Mcc","code_information":[{"code":"070","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13825.29,"maximum":69537.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24647.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44013.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14793.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41813.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28974.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43914.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29007.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30951.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26688.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49772.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69537.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30282.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36840.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39191.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14793.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28406.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14793.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14240.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36419.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14793.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30712.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13825.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14378.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15373.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18249.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14793.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27292.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14654.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13825.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32893.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39961.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14516.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37254.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32893.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13825.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14793.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15265.98,"10th_percentile":15265.98,"90th_percentile":15265.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without Thrombolytic","code_information":[{"code":"069","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7272.88,"maximum":33365.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11826.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21118.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20062.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13902.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21070.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13918.29},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14851.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12805.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23881.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33365.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14530.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17676.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18804.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13629.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7491.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17474.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14736.26},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7272.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7563.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8087.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9600.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7781.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14357.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7709.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7272.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15782.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19174.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7636.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17875.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15782.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7272.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7781.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8028.9,"10th_percentile":8028.9,"90th_percentile":8028.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":7530.64,"10th_percentile":7530.64,"90th_percentile":7530.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7769.23,"maximum":36105.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12797.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22853.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8313.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21710.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15044.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22801.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15061.31},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16070.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8002.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8002.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13857.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25842.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36105.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15723.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19128.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20348.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8313.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14749.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8313.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8002.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18909.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8313.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15946.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7769.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8080.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8639.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10255.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8313.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15337.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8235.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7769.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17078.82},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20749.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8157.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19343.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17078.82},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7769.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8313.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8582.76,"10th_percentile":8582.76,"90th_percentile":8582.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12341.54,"maximum":61346.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21744.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38829.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13205.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36887.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25561.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38741.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25590.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27306.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12711.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12711.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23544.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43909.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61346.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26715.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32500.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34574.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13205.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25060.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13205.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12711.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32129.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13205.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27094.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12835.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13723.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16290.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13205.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24363.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13082.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29018.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35254.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12958.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32866.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29018.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12341.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13205.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6407.3,"maximum":28586.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10132.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18094.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17189.39},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11911.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18053.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11924.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12724.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10971.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20461.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28586.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12449.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15145.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16111.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11677.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14971.93},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12625.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6407.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6663.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7124.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8457.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6855.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12648.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6791.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6407.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13522.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16428.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6727.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15315.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13522.38},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6407.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6855.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8408.0,"10th_percentile":8408.0,"90th_percentile":8408.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Mcc","code_information":[{"code":"374","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17410.95,"maximum":89331.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31663.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56542.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18629.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53715.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37221.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56414.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37264.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39762.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17933.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17933.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34285.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63940.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89331.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38902.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":47327.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50347.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18629.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36492.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18629.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17933.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46786.2},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18629.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39454.74},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17410.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18107.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19360.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22982.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18629.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34370.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18455.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17410.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42256.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51337.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18281.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47859.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42256.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17410.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18629.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections Without Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6732.65,"maximum":30382.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10769.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19231.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7203.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18269.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12659.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19187.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12674.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13523.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6934.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6934.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11660.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21747.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30382.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13231.41},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16096.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17123.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7203.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12411.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7203.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6934.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15912.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7203.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13419.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6732.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7001.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7486.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8887.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7203.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13290.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7136.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6732.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14371.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17460.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7069.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16277.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14371.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6732.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7203.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Cc","code_information":[{"code":"372","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8954.11,"maximum":42646.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15115.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26993.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9580.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25643.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17769.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26931.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17789.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18982.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9222.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9222.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16367.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30524.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42646.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18571.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22593.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24035.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9580.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17421.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9580.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9222.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22335.4},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9580.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18835.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8954.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9312.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9956.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11819.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9580.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17676.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9491.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8954.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20172.92},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24508.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9401.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22847.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20172.92},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8954.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9580.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3037.44,"10th_percentile":3037.44,"90th_percentile":3037.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With Mcc","code_information":[{"code":"371","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14644.72,"maximum":74060.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26250.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46877.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15669.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44533.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30859.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46770.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30894.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32965.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15084.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15084.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28424.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53010.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74060.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32252.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39236.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41740.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15669.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30254.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15669.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15084.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38788.34},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15669.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32710.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14644.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15230.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16284.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19331.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15669.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28910.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15523.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14644.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35032.91},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42561.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15376.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39678.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35032.91},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14644.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15669.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without Cc/Mcc","code_information":[{"code":"370","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6531.39,"maximum":29271.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10375.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18527.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6988.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17601.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12196.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18485.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12210.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13029.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6727.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6727.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11234.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20951.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29271.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12747.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15508.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16497.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6988.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11957.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6988.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6727.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15330.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6988.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12928.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6531.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6792.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7262.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8621.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6988.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12893.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6923.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6531.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13846.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16822.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6857.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15682.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13846.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6531.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6988.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Cc","code_information":[{"code":"369","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8796.73,"maximum":41777.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14807.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26443.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9412.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25121.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17407.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26383.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17427.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18595.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9060.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9060.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16034.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29902.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41777.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18193.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22133.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23545.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9412.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17066.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9412.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9060.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21880.38},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9412.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18451.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8796.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9148.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9781.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11611.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9412.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17365.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9324.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8796.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19761.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24008.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9236.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22382.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19761.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8796.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9412.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With Mcc","code_information":[{"code":"368","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13273.71,"maximum":66492.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23568.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42086.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39982.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27705.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41991.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27737.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29596.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13671.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13671.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25519.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47593.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66492.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28956.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35227.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37474.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27162.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13671.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34824.4},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29367.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13273.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13804.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14760.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17521.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14202.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14070.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13273.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31452.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38211.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13937.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35623.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31452.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13273.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14202.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device Without Mcc","code_information":[{"code":"360","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19496.22,"maximum":100842.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35743.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63829.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20860.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":60637.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42018.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":63684.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42066.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":44886.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20081.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20081.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38703.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72180.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":100842.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43916.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":53426.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56835.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20860.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41195.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20860.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20081.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":52815.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20860.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44539.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19496.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20276.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21679.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25735.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20860.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38487.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20665.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19496.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47701.74},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57952.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20471.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":54027.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47701.74},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19496.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20860.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy With Intraluminal Device With Mcc","code_information":[{"code":"359","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27246.37,"maximum":143626.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50908.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90909.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":86363.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":59845.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":90703.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":59914.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":63930.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28063.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28063.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":55124.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":102803.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":143626.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":62548.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":76092.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80948.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":58672.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28063.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":75222.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63435.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27246.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28336.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30297.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35965.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29153.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53787.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28881.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27246.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":67939.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82540.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28608.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":76948.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":67939.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27246.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29153.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"358","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11805.85,"maximum":58388.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20695.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36957.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12632.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35109.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24329.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36873.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24357.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25989.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12160.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12160.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22409.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41793.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58388.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25427.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30934.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32907.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12632.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23852.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12632.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12160.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30580.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12632.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25788.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11805.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12278.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13128.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15583.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12632.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23305.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12514.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11805.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27619.71},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33555.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12396.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31282.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27619.71},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11805.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12632.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Cc","code_information":[{"code":"357","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18824.34,"maximum":97133.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34429.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61481.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20142.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":58407.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40473.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61342.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40519.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43235.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19389.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19389.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37280.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69525.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97133.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42300.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":51460.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54744.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20142.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39680.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20142.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19389.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":50872.64},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20142.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42900.82},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18824.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19577.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20932.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24848.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20142.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37161.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19953.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18824.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45947.23},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55821.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19765.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":52040.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45947.23},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18824.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20142.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures With Mcc","code_information":[{"code":"356","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34466.13,"maximum":183482.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":65035.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116136.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36878.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":110329.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":76452.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":115873.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":76540.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":81670.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":70420.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":131331.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":183482.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":79905.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":97208.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103410.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36878.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":74954.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36878.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35500.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":96096.89},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36878.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81038.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34466.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35844.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38326.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":45495.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36878.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":68039.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36534.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34466.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":86792.94},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105444.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36189.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":98302.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":86792.94},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34466.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36878.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":92916.1,"10th_percentile":92916.1,"90th_percentile":92916.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11405.59,"maximum":56179.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19912.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35559.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12203.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33781.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23408.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35478.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23435.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25006.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11747.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11747.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21561.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40211.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56179.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24465.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29763.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31662.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12203.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22949.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12203.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11747.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29423.22},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12203.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24812.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11405.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11861.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12683.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15055.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12203.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22515.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12089.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11405.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26574.51},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32285.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11975.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30098.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26574.51},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11405.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12203.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Cc","code_information":[{"code":"354","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13958.46,"maximum":70272.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24907.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44479.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14935.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42255.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29280.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44378.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29314.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31279.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14377.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14377.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26970.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50298.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70272.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30602.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37229.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39605.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14935.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28706.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14935.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14377.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36804.18},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14935.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31036.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13958.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14516.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15521.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18425.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14935.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27555.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13958.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33240.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40384.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14656.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37648.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33240.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13958.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14935.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With Mcc","code_information":[{"code":"353","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23186.3,"maximum":121213.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42964.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76723.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24809.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72886.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50506.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76548.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50564.45},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53953.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23881.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23881.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46521.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86761.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":121213.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52787.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":64218.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68315.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24809.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49516.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24809.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23881.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":63484.15},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24809.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53536.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23186.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24113.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25783.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30605.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24809.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45772.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24577.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23186.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57337.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69659.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24345.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64940.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57337.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23186.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24809.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without Cc/Mcc","code_information":[{"code":"352","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10064.84,"maximum":48777.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17289.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30874.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29330.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20324.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30804.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20347.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21711.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10366.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10366.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18721.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34913.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48777.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21242.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25842.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27491.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19926.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10366.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25546.79},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21543.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10064.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10467.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11192.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13285.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10769.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19869.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10668.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10064.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23073.39},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28031.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10568.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26133.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23073.39},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10064.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10769.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Cc","code_information":[{"code":"351","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12763.74,"maximum":63676.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22570.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40304.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13657.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38289.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26532.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40213.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26562.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28343.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13146.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13146.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24439.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45577.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63676.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27730.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33735.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35888.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13657.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26012.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13657.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13146.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33349.96},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13657.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28123.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12763.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13274.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14193.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16848.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13657.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25196.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13529.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12763.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30121.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36594.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13401.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34115.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30121.07},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12763.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13657.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With Mcc","code_information":[{"code":"350","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20083.37,"maximum":104084.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36892.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65880.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21489.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":62586.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43369.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":65731.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":43418.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46329.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20685.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20685.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39947.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74500.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":104084.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45327.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":55143.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58661.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21489.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42519.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21489.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20685.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":54512.8},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21489.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45970.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20083.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20886.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22332.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26510.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21489.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39646.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21288.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20083.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49234.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59815.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21087.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55763.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":49234.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20083.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21489.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without Cc/Mcc","code_information":[{"code":"349","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7816.14,"maximum":36364.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12889.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23016.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8363.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21865.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15151.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22964.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15169.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16186.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8050.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8050.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13956.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26028.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36364.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15836.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19265.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20494.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8363.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14855.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8363.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8050.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19045.25},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8363.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16060.83},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7816.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8128.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8691.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10317.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8363.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15429.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8285.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7816.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17201.31},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20897.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8206.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19482.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17201.31},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7816.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8363.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Cc","code_information":[{"code":"348","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11131.69,"maximum":54667.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19376.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34602.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11910.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32871.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22778.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34523.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22804.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24333.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11465.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11465.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20981.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39129.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54667.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23807.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28962.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30810.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11910.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22332.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11910.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11465.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28631.31},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11910.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24144.74},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11131.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11576.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12378.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14693.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11910.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21975.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11799.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11131.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25859.27},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31416.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11688.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29288.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25859.27},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11131.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11910.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9653.43,"10th_percentile":9653.43,"90th_percentile":9653.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures With Mcc","code_information":[{"code":"347","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18598.1,"maximum":95884.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33986.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60691.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19899.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":57656.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39952.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60553.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39998.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42679.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19156.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19156.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36800.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68631.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95884.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41756.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":50799.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54040.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19899.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39169.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19899.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19156.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":50218.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19899.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42349.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18598.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19342.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20681.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24549.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19899.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36714.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19713.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18598.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45356.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55103.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19528.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":51370.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45356.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18598.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19899.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"346","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10204.06,"maximum":49546.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17561.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31360.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10918.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29792.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20644.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31289.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20668.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22053.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10510.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10510.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19015.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35463.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49546.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21576.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26249.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27924.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10918.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20240.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10918.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10510.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25949.31},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10918.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21883.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10204.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10612.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11346.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13469.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10918.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20143.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10816.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10204.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23436.94},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28473.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10714.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26544.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23436.94},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10204.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10918.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":17561.69,"10th_percentile":17561.69,"90th_percentile":17561.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Cc","code_information":[{"code":"345","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12613.93,"maximum":62849.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22277.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39781.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13496.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37792.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26187.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39690.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26217.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27975.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12992.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12992.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24121.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44986.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62849.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27370.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33297.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35422.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13496.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25674.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13496.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12992.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32916.82},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13496.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27758.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12613.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13118.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14026.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16650.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13496.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24901.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13370.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12613.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29729.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36118.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13244.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33672.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29729.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12613.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13496.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With Mcc","code_information":[{"code":"344","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20771.14,"maximum":107880.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38238.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68284.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22225.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":64869.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44951.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68129.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":45002.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48019.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21394.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21394.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41404.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77217.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107880.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46981.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":57154.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60801.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22225.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":44070.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22225.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21394.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":56501.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22225.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47647.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20771.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21601.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23097.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27417.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22225.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41004.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22017.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20771.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51030.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61997.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21809.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":57797.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51030.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20771.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22225.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without Cc/Mcc","code_information":[{"code":"337","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12843.18,"maximum":64115.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22725.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40582.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13742.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38553.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26715.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40490.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26745.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28538.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13228.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13228.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24607.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45891.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64115.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27921.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33968.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36135.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13742.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26191.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13742.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13228.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33579.66},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13742.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28317.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12843.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13356.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14281.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16953.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13742.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25353.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13613.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12843.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30328.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36846.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13485.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34350.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30328.53},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12843.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13742.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Cc","code_information":[{"code":"336","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17183.97,"maximum":88078.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31219.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55749.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52962.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36699.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55623.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36741.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39204.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17699.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17699.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33804.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63043.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88078.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38357.25},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46663.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49640.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35980.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17699.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46129.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38901.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17183.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17871.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19108.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22682.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18386.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33922.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18215.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17183.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41663.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50617.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18043.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47188.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41663.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17183.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18386.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With Mcc","code_information":[{"code":"335","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28247.39,"maximum":149152.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52867.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94407.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30224.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89686.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62147.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":94193.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62219.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":66390.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29094.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29094.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57245.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":106759.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":149152.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64954.67},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":79020.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84062.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30224.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60930.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30224.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29094.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":78117.01},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30224.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65875.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28247.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29377.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31411.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37286.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30224.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55763.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29942.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28247.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70553.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85715.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29659.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":79909.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":70553.84},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28247.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30224.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without Cc/Mcc","code_information":[{"code":"334","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13621.76,"maximum":68413.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24249.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43302.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14575.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41137.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28506.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43204.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28538.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30451.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14030.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14030.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26257.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48968.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68413.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29793.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36245.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38557.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14575.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27947.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14575.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14030.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35830.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14575.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30215.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13621.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14166.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15147.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17980.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14575.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26890.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14439.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13621.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32361.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39316.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14302.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36652.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32361.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13621.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14575.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Cc","code_information":[{"code":"333","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18950.69,"maximum":97831.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34676.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61923.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20277.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":58826.7},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40763.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61782.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40810.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43546.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19519.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19519.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37547.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70024.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97831.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42604.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":51830.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55137.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20277.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39964.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20277.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19519.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":51237.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20277.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43208.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18950.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19708.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21073.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25014.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20277.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37410.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20087.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18950.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46277.19},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56222.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19898.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":52413.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":46277.19},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18950.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20277.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With Mcc","code_information":[{"code":"332","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28624.2,"maximum":151233.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53604.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95724.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30627.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":90937.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":63014.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":95506.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":63087.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":67316.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29482.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29482.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":58043.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":108248.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":151233.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65860.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":80122.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85234.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30627.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":61780.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30627.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29482.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":79206.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30627.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66794.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29769.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31830.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37783.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30627.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56507.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30341.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71537.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86911.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30055.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":81024.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":71537.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28624.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30627.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures Without Cc/Mcc","code_information":[{"code":"331","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13962.24,"maximum":70293.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24915.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44492.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14939.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42267.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29289.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44391.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29322.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31288.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14381.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14381.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26978.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50313.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70293.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30611.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37240.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39617.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14939.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28715.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14939.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14381.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36815.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14939.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31046.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13962.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14520.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15526.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18430.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14939.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27562.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14799.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13962.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33250.74},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40396.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14660.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37659.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33250.74},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13962.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14939.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Cc","code_information":[{"code":"330","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19366.84,"maximum":100128.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35490.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63377.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20722.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":60208.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41720.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":63233.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41768.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":44568.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19947.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19947.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38429.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71669.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":100128.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43605.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":53047.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56432.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20722.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40903.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20722.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19947.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":52441.15},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20722.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44223.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20141.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21535.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25564.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20722.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38232.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20528.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47363.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57542.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20335.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53644.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47363.88},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19366.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20722.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":61625.98,"10th_percentile":61625.98,"90th_percentile":61625.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11132.99,"10th_percentile":11132.99,"90th_percentile":11132.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36007.38,"maximum":191991.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68051.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121522.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38527.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":115445.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":79997.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":121246.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":80089.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":85458.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37087.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37087.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":73686.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":137421.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":191991.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":83610.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":101715.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108206.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38527.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":78430.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38527.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37087.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":100553.03},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38527.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84796.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36007.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37447.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40040.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47529.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38527.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":71082.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38167.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36007.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90817.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110334.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37807.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":102860.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":90817.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36007.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38527.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":15806.6,"10th_percentile":15806.6,"90th_percentile":15806.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":18253.69,"10th_percentile":18253.69,"90th_percentile":18253.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":108851.7,"10th_percentile":108851.7,"90th_percentile":108851.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures Without Cc/Mcc","code_information":[{"code":"328","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13352.4,"maximum":66926.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23722.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42361.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14287.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40243.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27886.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42265.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27918.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29789.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13752.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13752.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25686.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47903.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66926.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29145.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35457.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37719.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14287.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27340.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14287.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13752.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35051.91},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14287.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29559.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13886.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14847.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17625.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14287.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26358.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14153.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31658.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38461.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14020.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35856.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31658.24},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13352.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14287.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Cc","code_information":[{"code":"327","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19722.46,"maximum":102091.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36186.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64619.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61388.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42538.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64473.11},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42587.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45442.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20314.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20314.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39182.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73074.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":102091.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44460.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":54087.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57538.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41705.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20314.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":53469.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45090.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19722.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20511.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21931.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26033.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21103.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38934.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20905.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19722.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48292.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58670.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20708.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":54696.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48292.5},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19722.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21103.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal And Duodenal Procedures With Mcc","code_information":[{"code":"326","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38965.04,"maximum":208318.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":73838.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131856.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41692.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":125263.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":86800.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":131557.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":86900.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":92725.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40133.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":40133.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":79953.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":149108.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":208318.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":90720.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":110366.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117408.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41692.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":85100.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41692.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40133.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":109104.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41692.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92007.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40523.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43329.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":51433.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41692.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76920.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41302.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":98541.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119717.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40913.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":111608.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":98541.05},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38965.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41692.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy Without Intraluminal Device","code_information":[{"code":"325","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25519.75,"maximum":134095.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47529.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84876.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":80632.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":55873.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":84683.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55938.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59687.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26285.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26285.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51465.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":95981.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134095.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58397.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":71042.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75576.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":54779.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26285.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":70230.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59225.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25519.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26540.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28377.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33686.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27306.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50378.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27050.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25519.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63431.08},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77062.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26795.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71842.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63431.08},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25519.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27306.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device Without Mcc","code_information":[{"code":"324","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25070.31,"maximum":131614.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46650.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83306.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":79140.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":54840.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83117.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54903.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58583.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25822.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25822.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50513.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":94205.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":131614.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57316.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":69728.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74177.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":53765.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25822.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":68931.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58129.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25070.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26073.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27878.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33092.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26825.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49491.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26574.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25070.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62257.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75636.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26323.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70513.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62257.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25070.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26825.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32861.75,"10th_percentile":32861.75,"90th_percentile":32861.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Intravascular Lithotripsy With Intraluminal Device With Mcc","code_information":[{"code":"323","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33971.29,"maximum":180751.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":64067.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114407.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36349.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":108686.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":75314.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":114148.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":75400.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":80455.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34990.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34990.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":69372.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":129376.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":180751.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":78715.41},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":95761.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101871.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36349.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":73838.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36349.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34990.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":94666.2},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36349.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79831.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33971.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35330.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37776.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44842.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36349.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67062.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36009.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33971.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":85500.77},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103874.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35669.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":96838.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":85500.77},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33971.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36349.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14568.3,"maximum":73638.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26101.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46610.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15588.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44279.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30683.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46504.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30718.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32777.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15005.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15005.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28262.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52708.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73638.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32068.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39013.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41502.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15588.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30082.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15588.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15005.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38567.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15588.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32523.82},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14568.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15151.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16199.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19230.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15588.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28759.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15442.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14568.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34833.35},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42319.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15296.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39452.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34833.35},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14568.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15588.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16086.87,"10th_percentile":16086.87,"90th_percentile":16086.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":32921.01,"10th_percentile":32921.01,"90th_percentile":42319.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13200.64,"10th_percentile":13200.64,"90th_percentile":13200.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21815.29,"maximum":113645.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40281.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71932.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23342.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68335.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47352.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":71769.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47407.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50585.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22469.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22469.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43617.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81343.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":113645.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":49491.35},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":60208.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64050.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23342.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46425.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23342.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22469.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":59520.22},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23342.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50193.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21815.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22687.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24258.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28796.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23342.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43065.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23124.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21815.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53757.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65310.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22906.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":60886.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":53757.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21815.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23342.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":22965.47,"10th_percentile":22965.47,"90th_percentile":22965.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23410.48,"10th_percentile":23410.48,"90th_percentile":23410.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28597.19,"10th_percentile":28597.19,"90th_percentile":28597.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19428.13,"maximum":100466.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35610.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63591.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20788.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":60411.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41861.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":63447.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41909.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":44719.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20010.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20010.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38559.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71911.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":100466.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43752.41},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":53226.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56623.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20788.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41041.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20788.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20010.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":52618.34},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20788.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44372.97},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19428.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20205.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21604.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25645.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20788.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38353.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20593.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19428.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47523.92},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57736.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20399.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53825.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47523.92},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19428.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20788.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With Mcc","code_information":[{"code":"319","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":34996.52,"maximum":186410.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":66073.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117990.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37446.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":112090.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":77672.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":117722.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":77761.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":82974.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36046.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36046.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":71544.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":133427.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":186410.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":81180.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":98759.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105061.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37446.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":76150.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37446.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36046.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":97630.4},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37446.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82331.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34996.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36396.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38916.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46195.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37446.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69086.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37096.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34996.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":88177.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107127.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36746.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":99870.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":88177.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34996.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37446.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Coronary Atherectomy Without Intraluminal Device","code_information":[{"code":"318","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19556.0,"maximum":101172.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35860.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64038.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20924.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":60835.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42155.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":63892.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42204.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45033.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20142.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20142.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38830.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72416.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101172.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44059.82},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":53600.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57021.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20924.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41330.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20924.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20142.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":52988.05},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20924.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44684.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19556.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20338.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21746.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25813.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20924.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38605.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20729.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19556.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47857.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58142.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20533.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":54203.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47857.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19556.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20924.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac Ablation","code_information":[{"code":"317","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51820.93,"maximum":279288.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":98993.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176777.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55448.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":167938.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":116371.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":176376.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":116505.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":124315.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53375.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":53375.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":107191.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":199906.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":279288.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":121627.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":147965.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157406.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55448.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":114091.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55448.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53375.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":146273.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55448.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123352.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51820.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53893.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57624.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":68403.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55448.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102299.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54930.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51820.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":132111.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160502.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54411.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":149630.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":132111.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51820.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55448.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses Without Cc/Mcc","code_information":[{"code":"316","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6389.9,"maximum":28490.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10098.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18033.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6837.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17131.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11871.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17992.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11884.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12681.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6581.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6581.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10934.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20392.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28490.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12407.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15094.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16057.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6837.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11638.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6837.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6581.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14921.62},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6837.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12583.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6389.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6645.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7105.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8434.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6837.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12614.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6773.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6389.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13476.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16373.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6709.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15264.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13476.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6389.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6837.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7053.58,"10th_percentile":7053.58,"90th_percentile":7053.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2066.69,"10th_percentile":2066.69,"90th_percentile":2066.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Cc","code_information":[{"code":"315","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8517.54,"maximum":40236.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14261.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25467.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9113.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24194.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16765.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25409.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16784.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17909.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8773.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8773.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15442.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28799.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40236.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17522.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21316.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22677.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9113.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16436.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9113.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8773.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21073.15},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9113.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17770.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8517.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8858.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9471.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11243.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9113.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16814.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9028.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8517.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19032.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23123.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8943.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21556.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19032.88},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8517.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9113.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":22511.69,"10th_percentile":22511.69,"90th_percentile":22511.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11163.68,"10th_percentile":11163.68,"90th_percentile":11163.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17006.16,"maximum":87096.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30871.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55128.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18196.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52371.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36290.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55003.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36332.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38768.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17516.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17516.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33427.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62341.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87096.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37929.79},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46143.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49087.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18196.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35579.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18196.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17516.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45615.84},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18196.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38467.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17006.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17686.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18910.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22448.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18196.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33571.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18026.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17006.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41199.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50053.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17856.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46662.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41199.38},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17006.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18196.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18785.97,"10th_percentile":18785.97,"90th_percentile":18785.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15780.66,"10th_percentile":15780.66,"90th_percentile":15780.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chest Pain","code_information":[{"code":"313","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6676.66,"maximum":30073.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10659.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19035.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18083.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12530.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18992.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12545.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13386.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6876.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6876.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11542.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21525.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30073.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13096.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15932.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16949.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12285.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6876.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15750.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13282.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6676.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6943.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7424.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8813.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7144.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13180.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7077.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6676.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14225.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17282.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7010.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16112.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14225.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6676.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7144.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":18992.16,"10th_percentile":18992.16,"90th_percentile":18992.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8748.67,"10th_percentile":7368.74,"90th_percentile":8750.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":17282.88,"10th_percentile":17282.88,"90th_percentile":17282.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And Collapse","code_information":[{"code":"312","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7823.71,"maximum":36405.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12904.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23043.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8371.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21891.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15169.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22991.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15186.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16204.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8058.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8058.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13972.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26058.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36405.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15854.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19287.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20518.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8371.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14872.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8371.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8058.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19067.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8371.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7823.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8136.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8699.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10327.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8371.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15444.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8293.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7823.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17221.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20921.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8214.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19504.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17221.07},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7823.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8371.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8638.92,"10th_percentile":8637.17,"90th_percentile":10263.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2988.01,"10th_percentile":2988.01,"90th_percentile":2988.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6420.29,"10th_percentile":6420.29,"90th_percentile":6420.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina Pectoris","code_information":[{"code":"311","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6539.71,"maximum":29317.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10391.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18556.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17628.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12215.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18514.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12229.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13049.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6735.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6735.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11252.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20984.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29317.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12767.56},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15532.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16523.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11976.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6735.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15354.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12948.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6539.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6801.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7272.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8632.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6997.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12910.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6932.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6539.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13868.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16848.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6866.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15707.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13868.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6539.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6997.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7217.53,"10th_percentile":7217.53,"90th_percentile":7217.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without Cc/Mcc","code_information":[{"code":"310","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5512.21,"maximum":23645.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8381.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14966.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5898.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14218.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9852.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14932.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9863.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10524.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5677.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5677.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9075.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16924.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23645.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10297.36},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":12527.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13326.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5898.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":9659.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5898.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5677.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":12384.0},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5898.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10443.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5512.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5732.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6129.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7276.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5898.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10881.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5842.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5512.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11185.0},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13588.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5787.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12668.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11185.0},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5512.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5898.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":13541.11,"10th_percentile":13541.11,"90th_percentile":13541.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4417.52,"10th_percentile":4417.52,"90th_percentile":4417.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6086.36,"10th_percentile":6086.36,"90th_percentile":6086.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Cc","code_information":[{"code":"309","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6795.45,"maximum":30729.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10892.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19450.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7271.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18477.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12804.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19406.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12818.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13678.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6999.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6999.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11794.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21995.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30729.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13382.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16280.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17319.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7271.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12553.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7271.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6999.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16094.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7271.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13572.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6795.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7067.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7556.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8969.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7271.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13414.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7203.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6795.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14535.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17659.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7135.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16463.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14535.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6795.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7271.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7503.43,"10th_percentile":7499.93,"90th_percentile":8906.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7010.23,"10th_percentile":7010.23,"90th_percentile":7010.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10338.74,"maximum":50289.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17825.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31831.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30239.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20954.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31759.11},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20978.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22384.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10648.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10648.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19301.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35995.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50289.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21900.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26643.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28343.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20543.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10648.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26338.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22211.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10338.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10752.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11496.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13647.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20409.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10959.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10338.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23788.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28900.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10855.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26943.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23788.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10338.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":30315.52,"10th_percentile":30315.52,"90th_percentile":30315.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11416.24,"10th_percentile":11413.24,"90th_percentile":11421.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without Mcc","code_information":[{"code":"307","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8138.47,"maximum":38143.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13519.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24143.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8708.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22935.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15893.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24088.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15911.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16978.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8382.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8382.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14639.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27301.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38143.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16611.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20208.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21497.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8708.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15581.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8708.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8382.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19977.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8708.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16846.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8138.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8464.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9049.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10742.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8708.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16066.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8626.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8138.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18043.01},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21920.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8545.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20435.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18043.01},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8138.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8708.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13151.89,"maximum":65819.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23329.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41661.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14072.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39577.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27425.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41566.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27456.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29297.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13546.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13546.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25261.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47111.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65819.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28663.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34870.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37095.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14072.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26887.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14072.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13546.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34472.2},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14072.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29070.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13677.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14624.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17360.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14072.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25963.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13941.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31134.66},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37825.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13809.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35263.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31134.66},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14072.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension Without Mcc","code_information":[{"code":"305","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6942.24,"maximum":31539.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11179.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19963.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7428.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18965.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13141.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19918.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13156.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14038.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12105.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22575.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31539.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13735.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16709.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17775.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7428.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12884.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7428.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7150.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16518.57},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7428.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13930.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6942.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7219.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7719.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9163.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7428.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13704.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7358.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6942.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14919.27},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18125.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7289.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16897.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14919.27},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6942.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7428.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":19665.95,"10th_percentile":19665.95,"90th_percentile":19665.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6608.61,"10th_percentile":6608.61,"90th_percentile":6608.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7662.52,"10th_percentile":7662.01,"90th_percentile":9104.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5392.84,"10th_percentile":5392.84,"90th_percentile":5392.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertension With Mcc","code_information":[{"code":"304","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10232.81,"maximum":49705.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17617.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31461.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10949.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29888.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20710.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31389.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20734.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22124.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10539.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10539.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19076.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35577.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49705.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21646.1},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26333.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28013.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10949.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20304.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10949.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10539.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26032.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10949.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21953.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10232.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10642.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11378.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13507.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10949.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20200.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10846.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10232.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23512.02},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28564.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10744.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26629.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23512.02},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10232.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10949.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9777.84,"10th_percentile":9777.84,"90th_percentile":9777.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without Mcc","code_information":[{"code":"303","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6322.56,"maximum":28118.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9966.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17798.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6765.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16908.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11716.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17757.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11729.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12516.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6512.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6512.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10792.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20126.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28118.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12245.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14897.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15847.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6765.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11486.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6765.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6512.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14726.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6765.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12419.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6322.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6575.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8345.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6765.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12481.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6701.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6322.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13301.09},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16159.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6638.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15064.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13301.09},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6322.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6765.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6978.53,"10th_percentile":6978.53,"90th_percentile":6978.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2668.8,"10th_percentile":2668.8,"90th_percentile":2668.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With Mcc","code_information":[{"code":"302","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10282.75,"maximum":49980.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17715.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31635.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11002.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30053.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20825.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31563.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20849.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22247.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10591.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10591.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19182.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35774.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49980.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21766.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26479.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28169.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11002.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20417.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11002.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10591.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26176.82},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11002.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22074.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10282.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10694.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11434.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13573.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11002.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20299.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10899.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10282.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23642.42},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28723.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10796.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26777.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23642.42},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10282.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11002.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without Cc/Mcc","code_information":[{"code":"301","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6674.39,"maximum":30061.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10655.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19027.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7141.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18075.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12525.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18984.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12540.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13380.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6874.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6874.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11537.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21516.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30061.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13091.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15926.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16942.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7141.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12280.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7141.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6874.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15744.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7141.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13277.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6674.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6941.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7421.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8810.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7141.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13175.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7074.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6674.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14219.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17275.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7008.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16105.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14219.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6674.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7141.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Cc","code_information":[{"code":"300","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9305.94,"maximum":44588.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15804.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28222.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9957.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26811.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18578.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28158.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18600.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19846.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9585.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9585.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17113.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31915.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44588.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19417.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23622.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25130.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9957.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18214.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9957.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9585.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23352.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9957.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19693.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9678.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10348.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12283.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9957.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18370.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9864.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21091.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25624.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9771.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23888.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21091.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9305.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9957.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With Mcc","code_information":[{"code":"299","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13582.41,"maximum":68196.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24172.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43165.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14533.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41006.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28415.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43067.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28448.16},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30355.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13989.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13989.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26173.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48812.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68196.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29698.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36130.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38435.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14533.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27858.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14533.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13989.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35716.95},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14533.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30120.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13582.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14125.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15103.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17928.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14533.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26813.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14397.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13582.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32258.89},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39191.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14261.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36536.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32258.89},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13582.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14533.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17809.43,"10th_percentile":17809.43,"90th_percentile":17809.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4878.77,"10th_percentile":4878.77,"90th_percentile":4878.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4672.35,"maximum":19009.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":6737.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12031.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4999.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":11430.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":7920.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":12004.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":7929.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":8461.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4812.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":4812.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":7295.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":13606.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":19009.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":8278.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":10070.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10713.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4999.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":7765.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4999.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4812.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":9955.77},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4999.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8395.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4672.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4859.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5195.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6167.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4999.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9223.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4952.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4672.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":8991.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10924.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4905.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":10184.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":8991.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4672.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4999.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Cc","code_information":[{"code":"297","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6025.96,"maximum":26481.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9386.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16761.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6447.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15923.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11034.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16723.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11046.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11787.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6206.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6206.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10163.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18954.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26481.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11532.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14029.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14924.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6447.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10817.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6447.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6206.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13869.38},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6447.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11696.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6025.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6267.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6700.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7954.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6447.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11895.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6387.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6025.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12526.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15218.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6327.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14187.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12526.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6025.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6447.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With Mcc","code_information":[{"code":"296","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13046.72,"maximum":65239.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23123.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41293.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13959.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39228.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27183.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41199.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27214.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29038.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13438.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13438.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25038.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46696.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65239.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28410.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34563.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36768.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13959.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26650.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13959.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13438.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34168.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13959.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28813.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13046.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13568.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14507.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17221.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13959.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25755.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13829.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13046.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30860.02},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37491.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13699.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34952.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30860.02},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13046.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13959.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5511.45,"maximum":23641.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8379.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14963.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5897.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14215.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9850.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14929.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9861.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10523.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5676.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5676.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9073.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16921.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23641.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10295.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":12525.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13324.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5897.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":9657.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5897.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5676.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":12381.82},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5897.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10441.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5511.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5731.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6128.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7275.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5897.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10880.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5842.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5511.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11183.03},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13586.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5787.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12665.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11183.03},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5511.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5897.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Cc","code_information":[{"code":"292","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7652.71,"maximum":35461.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12569.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22445.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21323.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14776.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22394.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14792.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15784.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7882.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7882.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13610.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25382.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35461.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15443.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18787.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19986.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14486.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7882.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18572.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15662.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7652.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7958.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8509.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10101.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15107.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8111.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7652.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16774.54},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20379.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8035.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18998.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16774.54},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7652.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":100.0,"10th_percentile":100.0,"90th_percentile":100.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock With Mcc","code_information":[{"code":"291","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10942.53,"maximum":53623.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19006.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33941.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11708.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32243.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22343.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33864.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22368.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23868.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11270.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11270.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20580.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38381.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53623.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23352.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28409.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30221.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11708.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21905.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11708.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11270.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28084.41},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11708.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23683.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10942.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11380.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12168.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14444.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11708.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21601.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11599.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10942.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25365.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30816.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11489.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28728.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25365.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10942.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11708.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":30708.5,"10th_percentile":30708.5,"90th_percentile":30708.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":11510.85,"10th_percentile":11510.85,"90th_percentile":11510.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8502.68,"10th_percentile":8502.68,"90th_percentile":10759.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":12081.24,"10th_percentile":7000.07,"90th_percentile":14348.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4787.08,"10th_percentile":4787.08,"90th_percentile":4787.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4787.08,"10th_percentile":4787.08,"90th_percentile":4787.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9639.49,"10th_percentile":9639.49,"90th_percentile":9639.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without Cc/Mcc","code_information":[{"code":"290","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8263.31,"maximum":38832.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13764.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24579.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8841.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23350.35},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16180.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24523.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16199.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17284.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8511.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8511.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14904.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27795.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38832.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16911.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20573.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21886.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8841.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15863.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8841.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8511.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20338.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8841.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17151.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8263.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8593.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9188.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10907.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8841.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16312.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8759.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8263.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18369.01},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22316.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8676.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20804.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18369.01},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8263.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8841.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Cc","code_information":[{"code":"289","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14143.83,"maximum":71295.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25270.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45127.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15133.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42870.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29706.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45024.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29741.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31734.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14568.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14568.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27363.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51031.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71295.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31048.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37771.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40182.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15133.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29124.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15133.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14568.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37340.14},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15133.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31488.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14143.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14709.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15727.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18669.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15133.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27921.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14992.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14143.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33724.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40972.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14851.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38197.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33724.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14143.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15133.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21704.82,"maximum":113035.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40065.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71546.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23224.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":67968.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47098.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":71384.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47152.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50313.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22355.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22355.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43383.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":80907.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":113035.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":49225.78},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":59885.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63706.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23224.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46175.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23224.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22355.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":59200.83},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23224.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49923.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21704.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22573.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24135.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28650.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23224.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42847.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23007.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21704.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53469.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64959.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22790.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":60559.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":53469.1},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21704.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23224.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without Mcc","code_information":[{"code":"287","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9325.62,"maximum":44697.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15842.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28291.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9978.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26876.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18624.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28227.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18645.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19895.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9605.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9605.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17154.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31992.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44697.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19465.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23680.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25191.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9978.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18259.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9978.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9605.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23409.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9978.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19741.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9325.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9698.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10370.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12309.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9978.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18409.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9885.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9325.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21143.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25686.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9791.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23946.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21143.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9325.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9978.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10295.7,"10th_percentile":10295.7,"90th_percentile":10295.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4736.9,"10th_percentile":4736.9,"90th_percentile":4736.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":25686.68,"10th_percentile":25686.68,"90th_percentile":25686.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With Mcc","code_information":[{"code":"286","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17971.62,"maximum":92426.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32760.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58502.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19229.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":55576.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38511.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58369.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38555.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41140.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18510.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18510.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35473.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66156.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":92426.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40250.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48967.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52091.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19229.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37757.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19229.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18510.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":48407.21},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19229.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40821.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18690.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19984.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23722.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19229.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35477.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19049.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43720.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53116.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18870.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49518.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43720.5},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17971.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19229.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":17220.04,"10th_percentile":17220.04,"90th_percentile":17220.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5760.38,"maximum":25015.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8866.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15833.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6163.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15041.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10423.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15797.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10435.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11134.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5933.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5933.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9600.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17905.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25015.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10893.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13253.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14098.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6163.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10219.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6163.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5933.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13101.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11048.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5760.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5990.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6405.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7603.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11371.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6106.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5760.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11833.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14376.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6048.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13402.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11833.07},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5760.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6163.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Cc","code_information":[{"code":"284","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6466.32,"maximum":28912.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10248.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18300.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6918.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17385.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12047.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18258.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12060.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12869.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6660.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6660.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11096.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20694.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28912.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12591.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15317.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16295.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6918.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11811.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6918.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6660.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15142.57},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6918.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12769.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6466.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6724.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7190.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8535.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6918.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12765.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6854.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6466.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13676.49},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16615.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6789.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15490.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13676.49},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6466.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6918.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16216.24,"maximum":82736.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29325.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52368.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":49749.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34473.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52249.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34513.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36827.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16702.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16702.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31754.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59219.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82736.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36030.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":43833.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46630.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33798.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16702.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43331.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36541.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16216.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16864.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18032.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21405.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17351.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32012.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17189.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16216.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39136.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47547.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17027.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44326.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39136.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16216.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17351.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without Cc/Mcc","code_information":[{"code":"282","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6700.11,"maximum":30203.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10705.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19117.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7169.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18161.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12584.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19073.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12599.29},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13443.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6901.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6901.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11592.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21618.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30203.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13153.19},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16001.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17022.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7169.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12338.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7169.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6901.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15818.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7169.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13339.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6700.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6968.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7450.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8844.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7169.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13226.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7102.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6700.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14287.01},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17357.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7035.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16181.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14287.01},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6700.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7169.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8784.82,"10th_percentile":8784.82,"90th_percentile":8784.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4162.61,"10th_percentile":4162.61,"90th_percentile":4162.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8183.11,"maximum":38389.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13607.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24299.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8755.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23084.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15996.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24244.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16014.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17087.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8428.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8428.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14734.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27478.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38389.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16718.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20338.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21636.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8755.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15682.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8755.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8428.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20106.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8755.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16955.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8183.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8510.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9099.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10801.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8755.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16154.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8674.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8183.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18159.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22062.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8592.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20567.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18159.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8183.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8755.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9034.79,"10th_percentile":9034.79,"90th_percentile":10721.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3786.05,"10th_percentile":3786.05,"90th_percentile":3786.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8442.54,"10th_percentile":8442.54,"90th_percentile":8442.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Mcc","code_information":[{"code":"280","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13366.02,"maximum":67001.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23748.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42409.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40288.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27917.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42312.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27949.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29823.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13767.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13767.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25715.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47957.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67001.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29178.58},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35497.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37762.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27370.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13767.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35091.29},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29592.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13366.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13900.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14863.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17643.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14301.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26385.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14167.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13366.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31693.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38504.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14034.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35896.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31693.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13366.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14301.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":14064.05,"10th_percentile":14064.05,"90th_percentile":14064.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13280.32,"10th_percentile":13280.32,"90th_percentile":13280.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14756.22,"10th_percentile":11164.74,"90th_percentile":17515.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12243.87,"10th_percentile":12243.87,"90th_percentile":12243.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without Mcc","code_information":[{"code":"279","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28516.0,"maximum":150635.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53392.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95346.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30512.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":90578.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62765.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":95129.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62837.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":67050.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29371.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29371.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57814.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":107820.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":150635.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65600.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":79806.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84898.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30512.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":61536.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30512.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29371.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":78893.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30512.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66530.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28516.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29656.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31709.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37641.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30512.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56293.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30226.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28516.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71255.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86568.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29941.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":80704.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":71255.25},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28516.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30512.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With Mcc","code_information":[{"code":"278","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43344.41,"maximum":232494.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":82407.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147159.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46378.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":139800.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":96874.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":146825.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":96985.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":103486.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44644.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44644.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":89231.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":166412.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":232494.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":101249.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":123174.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131033.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46378.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":94976.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46378.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44644.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":121766.19},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46378.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102685.26},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43344.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45078.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48198.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":57214.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46378.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85566.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45945.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43344.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":109976.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133611.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45511.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":124560.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":109976.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43344.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46378.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36173.84,"maximum":192910.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68376.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122103.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38706.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":115998.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":80380.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":121826.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":80472.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":85867.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37259.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37259.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":74039.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":138079.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192910.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":84010.52},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":102202.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108724.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38706.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":78805.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38706.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37259.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":101034.31},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38706.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85202.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36173.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37620.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40225.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47749.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38706.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":71410.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38344.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36173.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":91252.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110862.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37982.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":103352.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":91252.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36173.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38706.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus Neurostimulator","code_information":[{"code":"276","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46676.61,"maximum":250889.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":88927.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158802.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49943.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":150861.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":104538.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":158442.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":104659.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":111674.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48076.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":48076.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":96291.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":179579.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":250889.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":109260.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":132920.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141401.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49943.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":102490.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49943.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48076.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":131400.38},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49943.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110809.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46676.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48543.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51904.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":61613.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49943.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92144.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49477.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46676.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":118678.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144182.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49010.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":134415.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":118678.4},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46676.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49943.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":379.77,"10th_percentile":379.77,"90th_percentile":379.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46681.96,"10th_percentile":46681.96,"90th_percentile":46681.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And Mcc","code_information":[{"code":"275","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55179.6,"maximum":297829.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":105565.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188513.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":179087.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":124097.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":188085.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":124240.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":132568.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56834.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56834.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":114307.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":213177.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":297829.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":129701.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":157788.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167856.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":121666.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56834.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":155984.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131541.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57386.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61359.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":72837.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59042.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108930.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58490.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":140882.44},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171158.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57938.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":159564.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":140882.44},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55179.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59042.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26134.89,"maximum":137491.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48733.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87025.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27964.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":82674.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57288.75},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86828.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57354.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":61199.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26918.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26918.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52769.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":98411.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":137491.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59876.02},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":72842.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77489.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27964.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":56166.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27964.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26918.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":72009.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27964.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60725.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26134.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27180.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29062.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34498.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27964.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51592.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27702.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26134.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65037.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79013.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27441.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":73661.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":65037.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26134.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27964.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With Mcc","code_information":[{"code":"273","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32443.66,"maximum":172318.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61078.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109069.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34714.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":103616.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":71800.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":108822.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":71882.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":76701.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33416.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33416.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":66135.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":123340.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":172318.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":75042.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":91293.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97118.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34714.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":70393.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34714.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33416.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":90249.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34714.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76107.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32443.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33741.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36077.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":42825.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34714.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64047.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34390.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32443.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":81511.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99028.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34065.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":92320.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":81511.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32443.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34714.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without Cc/Mcc","code_information":[{"code":"272","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20545.67,"maximum":106636.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37797.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67496.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21983.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":64121.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44432.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67343.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44483.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47465.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21162.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21162.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40927.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":76327.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":106636.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46439.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":56495.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60100.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21983.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43561.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21983.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21162.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":55849.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21983.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47097.74},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20545.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21367.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22846.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27120.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21983.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40559.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21778.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20545.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50442.17},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61282.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21572.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":57131.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":50442.17},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20545.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21983.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Cc","code_information":[{"code":"271","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28136.93,"maximum":148543.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52651.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94021.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30106.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89320.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":61893.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93808.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":61964.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":66118.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28981.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28981.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57011.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":106322.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":148543.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64689.1},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":78697.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83718.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30106.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60681.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30106.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28981.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":77797.62},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30106.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65606.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28136.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29262.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31288.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37140.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30106.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55545.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29825.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28136.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70265.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85365.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29543.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":79582.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":70265.38},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28136.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30106.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":34221.36,"10th_percentile":34221.36,"90th_percentile":34221.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41150.94,"maximum":220385.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78115.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139494.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44031.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":132519.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":91828.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":139178.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":91934.25},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":98096.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42385.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":42385.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":84584.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":157745.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":220385.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":95975.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":116759.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124209.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44031.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":90029.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44031.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42385.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":115424.34},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44031.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97337.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41150.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42796.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45759.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":54319.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44031.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":81236.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43620.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41150.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":104249.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126652.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43208.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":118073.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":104249.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41150.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44031.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon Without Mcc","code_information":[{"code":"269","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33182.88,"maximum":176398.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62524.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111652.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35505.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":106069.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":73500.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111399.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":73585.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":78517.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34178.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34178.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67702.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":126261.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":176398.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":76820.01},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":93455.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99418.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35505.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":72060.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35505.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34178.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":92386.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35505.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77909.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33182.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34510.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36899.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43801.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35505.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65506.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35173.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33182.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":83441.99},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101373.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34842.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":94506.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":83441.99},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33182.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35505.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With Mcc","code_information":[{"code":"268","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53269.11,"maximum":287283.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":101827.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":181837.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56997.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":172745.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":119702.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":181425.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":119840.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":127873.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54867.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":54867.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":110259.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":205628.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":287283.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":125109.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":152201.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161912.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56997.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":117357.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56997.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54867.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":150460.94},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56997.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126883.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53269.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55399.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59235.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":70315.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56997.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":105158.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56465.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53269.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":135893.55},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":165097.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55932.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":153913.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":135893.55},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53269.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56997.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37250.52,"maximum":198853.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":70483.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125866.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39858.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":119572.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":82856.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":125580.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":82952.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":88512.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38368.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38368.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":76320.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":142333.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":198853.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":86598.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":105351.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112073.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39858.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":81233.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39858.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38368.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":104147.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39858.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87827.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37250.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38740.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41422.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":49170.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39858.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":73536.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39485.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37250.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94063.89},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114278.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39113.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":106537.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":94063.89},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37250.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39858.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures With Mcc","code_information":[{"code":"266","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47598.18,"maximum":255977.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":90730.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162022.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50930.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":153920.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":106658.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":161654.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":106781.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":113939.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49026.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":49026.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":98244.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":183220.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":255977.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":111475.6},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":135615.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144268.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50930.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":104568.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50930.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49026.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":134064.88},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50930.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113056.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47598.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49502.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":62829.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50930.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":93963.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50454.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47598.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":121084.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147106.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49978.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":137141.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":121084.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47598.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50930.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Lead Procedures","code_information":[{"code":"265","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28605.28,"maximum":151128.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53567.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95657.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30607.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":90874.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62971.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":95440.88},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":63043.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":67269.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29463.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29463.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":58003.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":108173.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":151128.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65815.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":80067.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85176.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30607.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":61737.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30607.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29463.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":79151.74},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30607.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66748.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28605.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29749.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31809.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37758.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30607.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56469.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30321.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28605.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71488.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86851.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30035.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":80968.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":71488.4},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28605.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30607.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":56636.83,"10th_percentile":56636.83,"90th_percentile":56636.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. Procedures","code_information":[{"code":"264","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26504.88,"maximum":139533.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":49457.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88318.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":83902.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":58139.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":88118.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":58206.61},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":62108.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27300.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27300.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":53553.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":99873.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":139533.52},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":60765.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":73924.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78641.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":57000.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27300.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":73078.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61627.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26504.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27565.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29473.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34986.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28360.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":52323.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28095.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26504.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":66003.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80187.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27830.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":74755.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":66003.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26504.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28360.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24362.1,"maximum":127704.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45264.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80831.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26067.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":76789.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":53210.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":80648.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":53272.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":56843.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":49013.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":91407.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":127704.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":55614.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":67657.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71974.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26067.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":52168.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26067.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25092.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":66883.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26067.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56402.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24362.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25336.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27090.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32157.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26067.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48093.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25823.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24362.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":60408.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73389.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25580.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":68418.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":60408.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24362.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26067.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13561.23,"maximum":68079.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24130.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43091.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40936.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28366.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42993.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28399.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30303.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13968.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13968.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26128.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48729.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68079.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29647.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36068.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38369.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27810.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13968.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35655.69},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30068.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13561.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14103.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15080.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17900.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26771.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14374.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13561.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32203.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39124.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14239.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36473.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32203.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13561.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14510.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15533.0,"maximum":78964.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27988.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49981.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47481.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32902.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49867.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32940.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35148.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15998.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15998.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30306.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56520.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78964.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34388.2},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":41834.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44504.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32257.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15998.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":41356.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34875.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15533.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16154.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17272.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20503.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30663.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16464.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15533.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37352.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45379.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16309.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42305.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37352.5},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15533.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25840.56,"maximum":135866.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48157.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85997.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27649.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":81697.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":56611.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":85802.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":56676.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60476.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26615.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26615.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52145.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":97248.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":135866.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59168.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":71981.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76574.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27649.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55502.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27649.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26615.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":71158.25},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27649.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60007.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25840.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26874.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28734.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34109.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27649.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51011.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27390.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25840.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":64268.82},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78080.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27132.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72791.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":64268.82},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25840.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27649.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without Mcc","code_information":[{"code":"259","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16528.72,"maximum":84461.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29937.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53460.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17685.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50787.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35192.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53338.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35233.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37594.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17024.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17024.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32416.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60454.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84461.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36782.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44747.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47602.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17685.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34503.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17685.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17024.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":44235.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17685.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37303.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16528.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17189.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18379.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21817.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17685.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32629.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17520.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16528.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39952.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48538.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17355.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45250.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39952.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16528.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17685.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With Mcc","code_information":[{"code":"258","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25002.97,"maximum":131242.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46518.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83070.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26753.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":78916.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":54685.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":82882.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54747.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58417.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25753.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25753.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50371.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":93939.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":131242.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57154.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":69531.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73968.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26753.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":53613.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26753.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25753.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":68736.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26753.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57965.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25002.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26003.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27803.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33003.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26753.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49358.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26503.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25002.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62081.61},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75422.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26253.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70313.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62081.61},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25002.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26753.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders Without Cc/Mcc","code_information":[{"code":"257","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9492.83,"maximum":45620.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16170.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28875.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10157.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27431.7},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19008.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28810.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19030.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20306.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9777.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9777.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17509.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32653.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45620.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19867.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24169.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25711.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10157.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18636.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10157.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9777.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23892.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10157.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20148.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9492.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9872.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10556.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12530.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10157.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18739.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10062.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9492.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21579.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26217.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9967.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24441.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21579.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9492.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10157.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Cc","code_information":[{"code":"256","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14075.73,"maximum":70919.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25137.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44889.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42644.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29550.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44787.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29584.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31567.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27219.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50762.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70919.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30884.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37572.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39970.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28971.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14498.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37143.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31322.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14075.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14638.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15652.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18579.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15061.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27786.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14920.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14075.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33547.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40756.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14779.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37995.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33547.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14075.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15061.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With Mcc","code_information":[{"code":"255","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21638.24,"maximum":112667.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39935.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71313.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23152.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":67747.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":46945.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":71152.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46999.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50150.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22287.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22287.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43242.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":80644.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":112667.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":49065.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":59690.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63499.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23152.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46025.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23152.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22287.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":59008.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23152.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49761.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21638.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22503.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24061.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28562.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23152.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42716.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22936.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21638.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53295.23},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64748.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22720.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":60362.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":53295.23},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21638.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23152.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14709.79,"maximum":74419.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26378.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47104.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15739.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44749.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31008.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46997.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31044.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33125.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15151.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15151.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28562.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53267.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74419.83},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32409.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39427.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41943.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15739.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30401.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15739.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15151.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38976.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15739.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32868.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14709.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15298.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16357.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19416.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15739.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29038.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15592.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14709.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35202.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42767.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15445.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39870.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35202.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14709.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15739.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20867.99,"maximum":108415.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38427.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68622.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":65191.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":45173.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68466.74},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":45225.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48257.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21494.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21494.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41610.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77600.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":108415.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47213.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":57438.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61103.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":44288.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21494.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":56781.35},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47883.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20867.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21702.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23205.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27545.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22328.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41195.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22120.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20867.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51283.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62304.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21911.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":58084.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51283.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20867.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22328.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27622.42,"maximum":145702.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51644.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92223.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29555.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":87612.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":60710.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":92014.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":60780.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":64854.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28451.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28451.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":55920.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":104289.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":145702.8},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":63452.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":77192.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82118.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29555.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":59520.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29555.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28451.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":76310.05},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29555.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64352.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27622.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28727.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30716.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36461.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29555.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54529.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29279.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27622.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":68921.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83733.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29003.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":78061.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":68921.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27622.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29555.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12536.75,"maximum":62423.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22126.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39511.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13414.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37535.86},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26010.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39421.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26040.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27785.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23958.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44681.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62423.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27184.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33071.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35182.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13414.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25500.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13414.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12912.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32693.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13414.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27570.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12536.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13038.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13940.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16548.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13414.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24748.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13288.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12536.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29528.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35873.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13163.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33443.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29528.33},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12536.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13414.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device With Mcc","code_information":[{"code":"250","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17742.36,"maximum":91160.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32311.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57700.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18984.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54815.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37984.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57569.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38027.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40577.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18274.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18274.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34987.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65250.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91160.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39699.68},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48296.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51378.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18984.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37240.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18984.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18274.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":47744.37},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18984.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40262.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17742.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18452.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19729.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23419.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18984.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35025.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18806.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17742.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43121.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52388.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18629.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48839.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43121.84},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17742.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18984.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aicd Generator Procedures","code_information":[{"code":"245","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35749.37,"maximum":190566.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67546.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120620.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38251.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":114589.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":79404.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":120346.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":79495.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":84824.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36821.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36821.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":73139.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":136402.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":190566.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":82990.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":100961.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107403.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38251.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":77848.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38251.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36821.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":99807.06},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38251.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84167.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35749.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37179.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39753.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47189.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38251.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70572.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37894.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35749.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90143.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109515.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37536.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":102097.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":90143.9},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35749.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38251.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without Cc/Mcc","code_information":[{"code":"407","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18023.07,"maximum":92710.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32861.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58681.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19284.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":55747.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38629.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58548.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38674.31},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41266.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18563.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18563.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35582.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66359.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":92710.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40374.52},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":49117.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52251.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19284.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37873.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19284.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18563.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":48555.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19284.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40947.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18023.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18743.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20041.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23790.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19284.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35579.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19104.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18023.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43854.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53279.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18924.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49670.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43854.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18023.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19284.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Mcc","code_information":[{"code":"408","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28207.29,"maximum":148931.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52788.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94267.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30181.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89553.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62055.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":94053.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62127.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":66291.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29053.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29053.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57160.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":106600.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":148931.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64858.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":78903.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83937.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30181.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60839.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30181.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29053.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":78001.07},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30181.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65778.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28207.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29335.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31366.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37233.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30181.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55684.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29899.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28207.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70449.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85588.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29617.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":79791.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":70449.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28207.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30181.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. With Cc","code_information":[{"code":"409","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17703.01,"maximum":90943.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32234.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57563.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18942.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54685.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37893.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57432.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37937.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40480.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18234.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18234.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34904.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65094.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90943.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39605.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48181.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51255.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18942.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37151.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18942.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18234.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":47630.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18942.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40166.83},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18411.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19685.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23367.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18942.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34947.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18765.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43019.09},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52263.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18588.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48723.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43019.09},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17703.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18942.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biliary Tract Procedures Except Only Cholecystectomy With Or Without C.D.E. Without Cc/Mcc","code_information":[{"code":"410","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13241.93,"maximum":66316.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23505.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41975.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14168.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39876.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27632.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41880.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27664.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29518.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13639.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13639.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25452.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47467.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66316.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28880.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35134.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37376.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14168.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27090.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14168.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13639.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34732.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14168.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29289.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13241.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13771.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14725.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17479.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14168.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26140.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14036.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13241.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31369.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38111.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13904.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35529.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31369.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13241.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14168.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Mcc","code_information":[{"code":"411","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26222.65,"maximum":137975.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48905.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87332.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28058.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":82965.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57490.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":87134.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57556.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":61414.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27009.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27009.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52955.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":98758.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":137975.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":60087.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":73098.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77762.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28058.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":56364.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28058.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27009.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":72262.99},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28058.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60939.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26222.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27271.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29159.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34613.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28058.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51766.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27796.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26222.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65266.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79292.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27533.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":73921.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":65266.6},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26222.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28058.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. With Cc","code_information":[{"code":"412","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17137.05,"maximum":87819.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31127.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55585.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18336.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52806.39},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36591.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55459.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36633.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39089.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17651.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17651.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33705.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62858.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87819.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38244.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46526.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49494.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18336.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35874.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18336.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17651.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45994.29},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18336.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38786.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17137.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17822.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19056.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22620.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18336.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33830.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18165.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17137.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41541.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50468.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17993.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47049.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41541.2},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17137.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18336.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy With C.D.E. Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13792.75,"maximum":69357.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24583.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43900.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14758.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41705.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28899.34},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43800.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28932.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30872.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14206.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14206.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26619.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49643.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69357.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30204.5},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36745.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39089.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14758.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28333.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14758.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14206.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36325.1},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14758.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30632.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14344.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15337.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18206.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14758.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27228.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32808.16},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39858.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14482.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37158.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32808.16},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14758.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28184.59,"maximum":148806.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52744.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94188.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30157.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89478.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62003.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93974.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62074.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":66235.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29030.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29030.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57112.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":106511.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":148806.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64803.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":78836.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83867.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30157.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60788.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30157.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29030.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":77935.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30157.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65722.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28184.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29311.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31341.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37203.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30157.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55639.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29875.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28184.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70389.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85516.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29593.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":79723.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":70389.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28184.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30157.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. With Cc","code_information":[{"code":"415","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16866.18,"maximum":86323.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30597.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54639.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18046.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":51907.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35968.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54515.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36010.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38424.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33131.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61788.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86323.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37593.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":45734.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48652.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18046.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35264.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18046.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17372.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45211.13},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18046.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38126.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16866.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17540.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18755.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22263.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18046.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33295.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17878.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16866.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40833.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49609.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17709.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46248.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40833.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16866.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18046.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cholecystectomy Except By Laparoscope Without C.D.E. Without Cc/Mcc","code_information":[{"code":"416","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11544.05,"maximum":56943.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20183.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36042.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12352.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34240.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23726.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35961.13},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23754.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25346.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11890.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11890.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21855.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40758.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56943.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24798.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30168.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32093.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12352.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23261.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12352.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11890.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29823.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12352.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25150.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11544.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12005.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12836.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15238.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12352.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22789.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12236.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11544.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26936.08},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32724.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12121.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30507.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26936.08},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11544.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12352.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Mcc","code_information":[{"code":"417","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19285.12,"maximum":99677.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35330.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63091.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20635.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":59936.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41532.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62948.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41580.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":44367.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19863.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19863.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38256.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71346.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":99677.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43408.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":52808.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56178.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20635.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40719.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20635.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19863.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":52204.89},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20635.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44024.31},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19285.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20056.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21445.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25456.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20635.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38070.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20442.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19285.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47150.49},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57283.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20249.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53402.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47150.49},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19285.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20635.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. With Cc","code_information":[{"code":"418","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14028.07,"maximum":70656.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25044.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44722.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42486.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29440.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44621.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29474.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31450.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14448.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14448.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27118.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50573.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70656.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30770.2},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37433.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39821.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28863.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14448.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37005.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31206.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14028.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14589.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15599.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18517.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27692.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14869.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14028.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33422.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40605.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14729.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37854.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33422.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14028.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15010.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13408.15,"10th_percentile":13408.15,"90th_percentile":13408.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15486.8,"10th_percentile":15486.8,"90th_percentile":15486.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5903.19,"10th_percentile":5903.19,"90th_percentile":5903.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopic Cholecystectomy Without C.D.E. Without Cc/Mcc","code_information":[{"code":"419","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11562.97,"maximum":57048.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20220.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36109.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12372.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34303.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23770.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36027.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23797.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25392.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11909.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11909.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21895.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40833.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57048.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24843.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30223.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32152.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12372.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23304.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12372.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11909.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29878.24},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12372.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25196.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11562.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12025.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12858.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15263.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12372.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22826.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12256.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11562.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26985.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32784.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12141.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30563.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26985.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11562.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12372.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":2567.81,"10th_percentile":2567.81,"90th_percentile":2567.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":36027.07,"10th_percentile":36027.07,"90th_percentile":36027.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12765.11,"10th_percentile":12765.11,"90th_percentile":12765.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":39554.24,"10th_percentile":39554.24,"90th_percentile":39554.24},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":32784.66,"10th_percentile":32784.66,"90th_percentile":32784.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Mcc","code_information":[{"code":"420","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27008.04,"maximum":142311.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50442.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90076.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28898.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":85572.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":59297.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":89872.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":59365.31},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":63344.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27818.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27818.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":54619.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":101862.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":142311.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":61975.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":75395.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80206.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28898.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":58135.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28898.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27818.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":74533.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28898.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62854.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27008.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28088.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30032.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35650.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28898.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53316.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28628.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27008.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":67317.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81784.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28358.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":76244.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":67317.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27008.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28898.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With Cc","code_information":[{"code":"421","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14375.36,"maximum":72573.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25723.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45936.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15381.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43639.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30239.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45831.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30274.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32303.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14806.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14806.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27853.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51946.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72573.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31605.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38449.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40902.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15381.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29646.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15381.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14806.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38009.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15381.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32053.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14375.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14950.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15985.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18975.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15381.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28378.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15237.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14375.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34329.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41706.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15094.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38881.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34329.53},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14375.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15381.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without Cc/Mcc","code_information":[{"code":"422","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11817.95,"maximum":58455.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20719.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36999.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12645.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35149.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24356.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36916.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24384.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26019.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12172.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12172.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22435.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41840.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58455.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25456.91},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30969.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32945.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12645.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23879.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12645.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12172.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30615.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12645.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25817.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11817.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12290.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13141.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15599.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12645.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23329.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12527.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11817.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27651.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33593.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12408.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31318.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27651.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11817.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12645.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Mcc","code_information":[{"code":"423","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32651.73,"maximum":173466.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61485.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109797.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34937.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":104306.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":72278.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":109547.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":72361.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":77212.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":66576.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":124162.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":173466.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":75543.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":91901.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97765.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34937.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":70862.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34937.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33631.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":90851.03},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34937.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76614.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33957.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36308.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43100.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34937.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64457.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34610.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":82054.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99688.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34284.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":92935.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":82054.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34937.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures With Cc","code_information":[{"code":"424","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17783.22,"maximum":91386.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32391.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57843.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19028.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54951.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38078.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57712.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38121.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40677.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18316.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18316.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35074.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65411.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91386.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39797.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48416.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51505.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19028.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37332.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19028.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18316.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":47862.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19028.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40362.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18494.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19774.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23473.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19028.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35105.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18850.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43228.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52518.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18672.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48960.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43228.53},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17783.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19028.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Hepatobiliary Or Pancreas O.R. Procedures Without Cc/Mcc","code_information":[{"code":"425","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12580.63,"maximum":62666.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22211.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39664.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13461.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37681.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26111.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39574.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26141.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27893.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12958.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12958.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24051.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44854.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62666.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27290.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33200.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35318.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13461.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25599.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13461.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12958.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32820.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13461.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27677.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12580.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13083.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13989.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16606.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13461.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24835.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13335.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12580.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29642.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36013.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13209.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33573.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29642.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12580.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13461.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or Custom-Made","code_information":[{"code":"426","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":84618.52,"maximum":460344.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":163168.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":291378.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":276808.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":191812.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":290717.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":192033.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":204906.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87157.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":87157.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":176680.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":329500.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":460344.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":200475.63},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":243888.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259450.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":188054.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87157.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":241099.77},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":203319.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84618.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88003.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94095.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":111696.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90541.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":167045.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89695.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84618.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":217756.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264552.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88849.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":246632.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":217756.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84618.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90541.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Cc","code_information":[{"code":"427","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55846.95,"maximum":301513.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":106871.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190845.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59756.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":181302.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":125632.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":190412.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":125776.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":134208.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57522.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":57522.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":115721.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":215814.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":301513.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":131306.33},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":159740.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169933.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59756.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":123170.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59756.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57522.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":157914.09},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59756.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133168.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55846.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58080.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62101.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":73717.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59756.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":110247.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59197.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55846.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":142625.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173275.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58639.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":161537.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":142625.1},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55846.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59756.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without Cc/Mcc","code_information":[{"code":"428","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43766.61,"maximum":234825.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":83233.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148634.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46830.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":141202.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":97845.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":148297.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":97957.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":104524.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45079.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":45079.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":90126.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":168080.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":234825.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":102264.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":124409.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132347.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46830.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":95928.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46830.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45079.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":122986.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46830.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103714.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43766.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45517.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48668.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":57771.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46830.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":86399.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46392.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43766.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":111079.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134950.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45954.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":125809.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":111079.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43766.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46830.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion With Mcc","code_information":[{"code":"429","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":69398.17,"maximum":376321.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":133387.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":238195.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74256.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":226285.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":156803.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":237655.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":156983.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":167506.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71480.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":71480.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":144432.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":269360.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":376321.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":163884.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":199373.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212094.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74256.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":153730.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74256.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71480.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":197094.01},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74256.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166209.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69398.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72174.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77170.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":91605.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74256.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":136998.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73562.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69398.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":178011.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216266.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72868.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":201616.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":178011.68},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69398.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74256.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without Mcc","code_information":[{"code":"430","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44864.48,"maximum":240886.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":85381.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152470.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":144846.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":100370.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":152124.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":100485.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":107221.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46210.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46210.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":92452.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":172418.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":240886.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":104903.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":127620.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135763.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":98404.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46210.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":126161.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106391.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44864.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46659.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49889.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":59221.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48004.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":88566.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47556.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44864.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":113946.36},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138433.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47107.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":129056.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":113946.36},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44864.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48004.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy With Cc","code_information":[{"code":"375","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10381.11,"maximum":50523.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17908.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31979.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30380.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21051.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31906.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21076.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22488.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10692.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10692.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19391.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36163.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50523.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22002.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26767.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28475.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20639.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10692.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26461.21},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22314.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10381.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10796.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11543.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13703.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11107.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20493.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11003.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10381.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23899.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29035.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10900.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27068.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23899.28},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10381.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11107.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without Cc/Mcc","code_information":[{"code":"376","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8222.45,"maximum":38607.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13684.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24436.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8798.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23214.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16086.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24381.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16105.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17184.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8469.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8469.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14817.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27633.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38607.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16813.02},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20453.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21758.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8798.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15771.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8798.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8469.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20219.99},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8798.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17051.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8222.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8551.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9143.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10853.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8798.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16231.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8715.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8222.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18262.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22186.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8633.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20683.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18262.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8222.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8798.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15060.11,"maximum":76353.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27063.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48328.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16114.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45912.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31814.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48218.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31851.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33986.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29304.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54651.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76353.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33251.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40451.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43032.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16114.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31191.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16114.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15511.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39989.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16114.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33722.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15060.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15662.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16746.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19879.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16114.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29730.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15963.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15060.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36117.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43879.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15813.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40906.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36117.62},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15060.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16114.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14929.58,"10th_percentile":14929.58,"90th_percentile":14929.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":16160.08,"10th_percentile":16160.08,"90th_percentile":16160.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8649.19,"maximum":40962.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14519.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25927.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9254.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24631.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17068.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25868.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17087.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18233.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8908.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8908.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15721.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29319.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40962.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17838.93},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21701.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23086.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9254.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16733.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9254.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8908.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21453.79},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9254.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18091.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8649.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8995.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9617.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11416.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9254.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17074.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9168.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8649.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19376.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23540.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9081.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21946.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19376.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8649.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9254.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":9093.62,"10th_percentile":9093.62,"90th_percentile":9093.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9548.75,"10th_percentile":9548.75,"90th_percentile":11340.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8923.64,"10th_percentile":8923.64,"90th_percentile":8923.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5998.72,"maximum":26331.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9333.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16666.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15833.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10971.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16628.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10984.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11720.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6178.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6178.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10105.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18847.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26331.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11466.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13950.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14840.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10756.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6178.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13790.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11629.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5998.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6238.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6670.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7918.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6418.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11842.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6358.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5998.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12455.44},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15132.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6298.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14107.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12455.44},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5998.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6418.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Mcc","code_information":[{"code":"380","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16075.5,"maximum":81959.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29050.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51876.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17200.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":49282.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34150.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51758.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34189.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36481.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16557.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16557.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31456.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58663.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81959.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35692.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":43421.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46192.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17200.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33481.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17200.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16557.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42925.09},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17200.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36198.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16075.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16718.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17875.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21219.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17200.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31734.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17040.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16075.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38769.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47100.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16879.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43910.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38769.15},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16075.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17200.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":46935.82,"10th_percentile":46935.82,"90th_percentile":46935.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With Cc","code_information":[{"code":"381","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9427.0,"maximum":45256.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16041.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28645.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10086.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27213.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18857.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28580.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18878.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20144.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9709.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9709.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17369.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32393.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45256.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19708.87},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23976.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25506.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10086.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18487.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10086.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9709.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23702.65},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10086.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19988.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9427.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9804.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10482.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12443.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10086.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18609.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9992.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9427.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21407.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26008.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9898.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24246.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21407.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9427.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10086.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without Cc/Mcc","code_information":[{"code":"382","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7286.5,"maximum":33440.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11852.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21166.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7796.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20107.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13933.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21118.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13949.65},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14884.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7505.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7505.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12834.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23935.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33440.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14562.91},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17716.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18846.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7796.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13660.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7796.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7505.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17513.93},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7796.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14769.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7286.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8102.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9618.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7796.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14384.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7723.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7286.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15818.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19217.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7650.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17915.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15818.25},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7286.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7796.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With Mcc","code_information":[{"code":"383","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11675.71,"maximum":57670.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20441.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36502.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12493.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34677.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24029.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36420.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24057.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25669.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12025.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12025.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22134.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41278.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57670.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25114.93},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30553.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32503.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12493.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23558.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12493.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12025.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30204.19},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12493.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25471.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11675.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12983.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15411.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12493.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23049.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12376.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11675.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27279.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33142.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30897.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27279.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11675.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12493.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer Without Mcc","code_information":[{"code":"384","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7696.59,"maximum":35704.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12655.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22599.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21469.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14876.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22547.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14894.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15892.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7927.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7927.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13703.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25555.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35704.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15548.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18915.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20122.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14585.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7927.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18699.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15769.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7696.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8004.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8558.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10159.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8235.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15193.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8158.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7696.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16889.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20518.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8081.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19128.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16889.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7696.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8235.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2728.26,"10th_percentile":2728.26,"90th_percentile":2728.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Mcc","code_information":[{"code":"385","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13201.07,"maximum":66091.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23425.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41832.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14125.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39741.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27538.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41737.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27570.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29418.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13597.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13597.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25365.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47306.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66091.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28782.04},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35014.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37248.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14125.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26998.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14125.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13597.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34614.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14125.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29190.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13201.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13729.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14679.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17425.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14125.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26060.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13993.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13201.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31263.08},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37981.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13861.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35408.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31263.08},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13201.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14125.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With Cc","code_information":[{"code":"386","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8615.9,"maximum":40779.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14454.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25811.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9219.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24520.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16991.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25752.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17011.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18151.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8874.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8874.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15651.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29188.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40779.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17758.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21604.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22983.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9219.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16658.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9219.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8874.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21357.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9219.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18010.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8960.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9580.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11372.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9219.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17008.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9132.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19289.74},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23435.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9046.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21847.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19289.74},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8615.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9219.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without Cc/Mcc","code_information":[{"code":"387","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6383.84,"maximum":28457.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10086.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18012.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6830.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17111.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11857.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17971.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11870.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12666.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6575.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6575.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10921.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20368.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28457.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12392.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15076.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16038.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6830.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11625.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6830.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6575.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14904.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6830.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12568.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6383.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6639.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7098.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8426.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6830.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12602.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6766.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6383.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13461.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16353.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6703.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15246.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13461.13},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6383.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6830.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12402.83,"maximum":61684.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21864.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39043.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37091.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25702.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38955.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25731.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27456.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12774.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12774.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23674.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44151.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61684.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26862.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32680.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34765.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25198.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12774.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32306.48},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27244.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12402.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12898.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13791.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16371.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13271.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24484.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13147.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12402.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29178.61},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35449.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13022.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33047.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29178.61},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12402.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13271.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12321.19,"10th_percentile":12321.19,"90th_percentile":12321.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":31118.77,"10th_percentile":31118.77,"90th_percentile":31118.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7204.79,"maximum":32989.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11692.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20880.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7709.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19836.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13745.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20833.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13761.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14683.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7420.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7420.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12661.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23612.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32989.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14366.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17477.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18592.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7709.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13476.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7709.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7420.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17277.66},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7709.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14570.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7204.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7492.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8011.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9510.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7709.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14222.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7637.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7204.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15604.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18958.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7565.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17674.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15604.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7204.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7709.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":19475.68,"10th_percentile":19475.68,"90th_percentile":19475.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9460.38,"10th_percentile":9460.38,"90th_percentile":9460.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2570.32,"10th_percentile":2570.32,"90th_percentile":2570.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5600.15,"10th_percentile":5600.15,"90th_percentile":5600.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5344.99,"maximum":22722.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8053.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14382.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5719.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13663.1},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9467.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14349.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9478.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10114.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5505.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5505.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8720.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16263.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":22722.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":9895.36},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":12038.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12806.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5719.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":9282.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5719.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5505.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":11900.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5719.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10035.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5344.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5558.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7055.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5719.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10551.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5665.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5344.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10748.35},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13058.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5612.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12173.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10748.35},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5344.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5719.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4247.07,"10th_percentile":4247.07,"90th_percentile":4247.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders With Mcc","code_information":[{"code":"391","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10825.26,"maximum":52975.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18777.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33531.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11583.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31854.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22073.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33455.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22098.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23580.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11150.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11150.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20332.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37918.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52975.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23070.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28066.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29857.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11583.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21641.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11583.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11150.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27745.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11583.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23397.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10825.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11258.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12037.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14289.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11583.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21370.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11474.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10825.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25059.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30444.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11366.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28382.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25059.07},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10825.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11583.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":11384.98,"10th_percentile":11384.98,"90th_percentile":11384.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3807.93,"10th_percentile":3807.93,"90th_percentile":3807.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2835.2,"10th_percentile":2835.2,"90th_percentile":2835.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11169.73,"10th_percentile":11169.73,"90th_percentile":11397.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7127.61,"maximum":32563.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11541.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20611.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7626.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19580.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13568.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20564.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13583.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14494.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7341.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7341.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12497.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23307.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32563.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14180.92},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17251.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18352.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7626.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13302.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7626.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7341.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17054.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7626.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14382.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7127.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7412.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7925.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9408.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7626.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14070.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7555.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7127.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15403.34},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18713.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7483.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17445.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15403.34},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7127.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7626.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":18648.03,"10th_percentile":18648.03,"90th_percentile":18648.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":7515.15,"10th_percentile":7515.15,"90th_percentile":7515.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":20564.29,"10th_percentile":20564.29,"90th_percentile":20564.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7306.38,"10th_percentile":941.15,"90th_percentile":7874.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14106.64,"10th_percentile":14106.64,"90th_percentile":14106.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2835.2,"10th_percentile":2835.2,"90th_percentile":2835.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5804.69,"10th_percentile":5804.69,"90th_percentile":6511.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":5581.07,"10th_percentile":5581.07,"90th_percentile":5581.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13329.7,"maximum":66801.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23677.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42282.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14262.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40168.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27834.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42186.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27866.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29734.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13729.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13729.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25638.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47814.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66801.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29091.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35390.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37649.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14262.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27288.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14262.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13729.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34986.29},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14262.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29503.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13862.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14822.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17595.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14262.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26314.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14129.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31598.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38389.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13996.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35789.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31598.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13329.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14262.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12458.14,"10th_percentile":12458.14,"90th_percentile":12458.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3068.05,"10th_percentile":3068.05,"90th_percentile":3068.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17482.17,"10th_percentile":17482.17,"90th_percentile":17482.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8308.71,"maximum":39083.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13853.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24738.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23501.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16284.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24681.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16303.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17396.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8557.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8557.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15000.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27974.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39083.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17020.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20706.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22027.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15965.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8557.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20469.37},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17261.79},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8308.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8641.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9239.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10967.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8890.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16402.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8807.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8308.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18487.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22460.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8724.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20939.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18487.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8308.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8890.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":22578.87,"10th_percentile":22578.87,"90th_percentile":22578.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9171.5,"10th_percentile":9171.0,"90th_percentile":9178.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5084.78,"10th_percentile":5084.78,"90th_percentile":5084.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6139.45,"maximum":27108.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9608.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17158.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6569.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16300.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11295.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17119.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11308.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12066.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10404.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19403.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27108.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11805.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14361.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15278.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6569.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11073.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6569.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6323.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14197.52},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6569.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11972.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6139.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6385.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6827.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8104.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6569.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12119.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6507.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6139.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12822.94},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15578.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6446.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14523.32},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12822.94},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6139.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6569.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":16003.69,"10th_percentile":16003.69,"90th_percentile":16003.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19349.44,"maximum":100032.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35456.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63316.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":60150.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41680.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":63172.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41728.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":44525.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19929.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19929.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38392.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71600.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":100032.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43563.23},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":52996.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56378.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40864.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19929.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":52390.83},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44181.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19349.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20123.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21516.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25541.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20703.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38197.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20510.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19349.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47318.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57487.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20316.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53593.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47318.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19349.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20703.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12681.27,"maximum":63221.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22408.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40016.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13568.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38015.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26342.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39925.74},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26372.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28140.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24264.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45252.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63221.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27532.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33494.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35631.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13568.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25826.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13568.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13061.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33111.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13568.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27922.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12681.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13188.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14101.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16739.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13568.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25034.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13442.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12681.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29905.71},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36332.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13315.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33871.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29905.71},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12681.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13568.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9890.06,"maximum":47812.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16947.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30263.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10582.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28750.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19922.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30194.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19945.25},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21282.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10186.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10186.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18350.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34223.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47812.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20822.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25331.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26947.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10582.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19532.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10582.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10186.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25041.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10582.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21117.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10285.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10997.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13054.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10582.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19523.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10483.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22616.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27477.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10384.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25616.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22616.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9890.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10582.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":27175.49,"10th_percentile":27175.49,"90th_percentile":27175.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12967.82,"10th_percentile":12967.82,"90th_percentile":12967.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Combined Anterior And Posterior Spinal Fusion Except Cervical","code_information":[{"code":"402","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31649.2,"maximum":167932.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":59523.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106293.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33864.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":100978.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":69972.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":106052.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":70053.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":74749.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":64452.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":120200.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":167932.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":73132.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":88969.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94646.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33864.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":68601.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33864.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32598.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":87952.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33864.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74170.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31649.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32915.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35193.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":41776.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33864.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62478.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33548.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31649.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":79437.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96508.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33231.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":89970.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":79437.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31649.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33864.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Mcc","code_information":[{"code":"405","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42620.32,"maximum":228497.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80990.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144629.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45603.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":137397.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":95208.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":144300.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":95317.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":101707.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43898.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43898.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":87697.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":163551.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":228497.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":99508.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":121056.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128781.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45603.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":93343.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45603.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43898.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":119672.66},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45603.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100919.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44325.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47393.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56258.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45603.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84136.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45177.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":108086.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131313.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44751.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":122418.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":108086.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42620.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45603.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With Cc","code_information":[{"code":"406","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23172.68,"maximum":121138.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42937.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76675.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24794.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72841.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50475.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76501.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50533.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53920.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23867.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23867.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46493.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86707.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":121138.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52754.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":64178.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68273.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24794.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49486.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24794.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23867.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":63444.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24794.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53502.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23172.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24099.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25768.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30587.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24794.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45745.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24563.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23172.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57302.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69616.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24331.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64900.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57302.15},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23172.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24794.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With Cc/Mcc","code_information":[{"code":"600","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9109.98,"maximum":43506.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15420.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27537.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9747.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26160.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18128.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27475.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18148.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19365.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9383.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9383.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16697.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31140.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43506.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18946.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23049.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24520.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9747.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17772.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9747.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9383.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22786.04},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9747.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19215.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9109.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9474.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10130.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12025.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9747.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17984.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9656.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9109.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20579.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25002.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9565.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23308.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20579.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9109.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9747.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"601","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5806.54,"maximum":25270.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8957.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15994.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15195.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10529.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15958.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10541.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11248.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5980.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5980.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9698.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18087.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25270.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11004.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13388.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14242.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10323.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5980.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13234.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6213.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11161.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5806.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6038.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6456.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7664.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6213.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11462.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6154.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5806.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11953.59},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14522.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6096.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13538.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11953.59},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5806.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6213.0,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis With Mcc","code_information":[{"code":"602","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11982.9,"maximum":59366.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21042.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37576.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12821.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35697.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24736.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37491.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24764.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26424.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12342.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12342.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22784.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42492.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59366.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25853.45},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31451.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33458.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12821.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24251.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12821.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12342.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31092.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12821.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26220.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11982.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12462.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13324.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15817.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12821.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23655.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12701.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11982.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28082.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34116.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12582.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31805.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28082.05},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11982.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12821.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":30301.86,"10th_percentile":30301.86,"90th_percentile":30301.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13228.35,"10th_percentile":13228.35,"90th_percentile":13228.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without Mcc","code_information":[{"code":"603","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7818.41,"maximum":36376.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12893.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23024.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8365.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21873.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15157.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22972.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15174.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16191.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8052.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8052.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13961.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26037.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36376.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15841.67},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19272.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20501.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8365.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14860.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8365.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8052.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19051.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8365.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16066.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7818.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8131.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8694.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10320.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8365.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15434.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8287.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7818.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17207.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20905.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8209.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19489.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17207.24},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7818.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8365.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":8219.76,"10th_percentile":8219.76,"90th_percentile":8219.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":21679.39,"10th_percentile":21679.39,"90th_percentile":21679.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3874.57,"10th_percentile":3874.57,"90th_percentile":3874.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10250.73,"10th_percentile":8633.06,"90th_percentile":10263.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2546.92,"10th_percentile":2546.92,"90th_percentile":3949.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6400.12,"10th_percentile":6400.12,"90th_percentile":6400.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12367.27,"maximum":61488.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21794.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38919.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36973.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25620.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38831.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25649.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27369.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23599.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44011.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61488.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26777.5},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32576.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34654.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25118.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12738.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32203.66},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27157.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12367.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12861.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13752.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16324.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13232.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24414.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13109.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12367.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29085.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35336.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12985.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32942.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29085.75},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12367.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13232.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8159.65,"maximum":38260.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13561.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24217.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8730.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23006.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15942.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24162.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15960.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17030.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8404.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8404.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14684.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27385.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38260.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16662.04},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20270.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21563.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8730.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15629.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8730.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8404.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20038.42},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8730.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16898.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8159.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8486.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9073.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10770.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8730.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16107.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8649.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8159.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18098.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21987.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8567.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20498.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18098.33},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8159.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8730.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":13561.38,"10th_percentile":13561.38,"90th_percentile":13561.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8753.77,"10th_percentile":8753.77,"90th_percentile":8753.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6767.04,"10th_percentile":6767.04,"90th_percentile":6767.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12678.24,"maximum":63204.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22402.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40005.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13565.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38005.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26335.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39915.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26366.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28133.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13058.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13058.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24258.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45240.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63204.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27525.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33485.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35622.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13565.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25819.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13565.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13058.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33102.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13565.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27915.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12678.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13185.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14098.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16735.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13565.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25028.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13438.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12678.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29897.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36322.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13312.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33862.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29897.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12678.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13565.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8087.02,"maximum":37859.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13419.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23963.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8653.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22765.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15774.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23909.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15793.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16851.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8329.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8329.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14530.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27098.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37859.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16487.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20057.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21337.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8653.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15465.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8653.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8329.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19828.41},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8653.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16721.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8087.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8410.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8992.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10674.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8653.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15964.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8087.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17908.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21757.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8491.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20283.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17908.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8087.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8653.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With Cc/Mcc","code_information":[{"code":"614","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17812.72,"maximum":91549.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32449.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57946.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19059.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":55049.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38146.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57815.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38189.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40749.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18347.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18347.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35136.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65528.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91549.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39868.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48502.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51597.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19059.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37398.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19059.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18347.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":47947.82},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19059.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40434.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17812.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18525.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19807.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23512.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19059.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35164.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18881.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17812.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43305.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52611.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18703.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49048.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43305.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17812.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19059.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures Without Cc/Mcc","code_information":[{"code":"615","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11816.44,"maximum":58447.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20716.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36994.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12643.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35144.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24353.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36910.74},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24381.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26015.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12170.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12170.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22432.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41834.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58447.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25453.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30965.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32940.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12643.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23876.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12643.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12170.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30611.09},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12643.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25814.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11816.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12289.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13139.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15597.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12643.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23326.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12525.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11816.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27647.37},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33588.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12407.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31313.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27647.37},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11816.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12643.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"616","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27615.61,"maximum":145665.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51630.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92199.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29548.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":87589.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":60694.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":91990.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":60764.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":64837.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28444.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28444.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":55906.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":104262.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":145665.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":63435.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":77172.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82096.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29548.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":59505.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29548.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28444.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":76290.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29548.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64335.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27615.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28720.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30708.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36452.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29548.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54515.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29272.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27615.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":68904.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83711.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28996.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":78041.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":68904.05},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27615.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29548.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21219.47,"10th_percentile":21219.47,"90th_percentile":21219.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"617","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15380.16,"maximum":78120.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27689.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49446.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46974.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32550.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49334.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32588.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34772.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29982.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55916.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78120.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34020.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":41387.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44028.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31912.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15841.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40914.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34503.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15380.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15995.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17102.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20301.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16456.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30361.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16302.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15380.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36953.39},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44894.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16149.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41853.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36953.39},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15380.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16456.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16984.7,"10th_percentile":16984.7,"90th_percentile":16984.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation Of Lower Limb For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"618","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11960.2,"maximum":59240.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20997.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37497.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12797.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35622.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24684.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37411.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24712.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26369.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12319.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12319.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22736.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42402.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59240.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25798.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31385.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33388.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12797.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24200.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12797.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12319.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31026.73},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12797.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26164.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11960.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12438.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13299.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15787.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12797.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23610.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12677.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11960.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28022.77},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34044.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12558.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31738.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28022.77},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11960.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12797.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Mcc","code_information":[{"code":"619","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23075.83,"maximum":120603.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42747.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76337.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72519.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50252.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76163.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50310.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53682.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23768.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23768.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46287.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86324.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120603.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52521.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":63895.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67972.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49267.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23768.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":63164.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53266.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23075.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23998.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25660.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30460.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24691.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45554.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24460.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23075.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57049.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69309.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24229.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64614.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57049.25},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23075.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24691.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity With Cc","code_information":[{"code":"620","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13337.26,"maximum":66842.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23692.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42308.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14270.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40193.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27851.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42212.71},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27883.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29752.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13737.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13737.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25654.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47844.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66842.93},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29109.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35413.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37672.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14270.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27305.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14270.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13737.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35008.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14270.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29522.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13337.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13870.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14831.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17605.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14270.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26329.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14137.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13337.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31618.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38413.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14004.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35811.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31618.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13337.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14270.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12641.92,"maximum":63004.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22331.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39879.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13526.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37884.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26252.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39788.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26282.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28044.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13021.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13021.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24181.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45096.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63004.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27437.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33379.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35509.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13526.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25737.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13526.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13021.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32997.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13526.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27826.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12641.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13147.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14057.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16687.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13526.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24956.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13400.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12641.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29802.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36207.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13274.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33754.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29802.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12641.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13526.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28158.87,"maximum":148664.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52693.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94098.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30129.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89392.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":61944.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93884.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62015.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":66172.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57057.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":106409.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":148664.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64741.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":78761.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83787.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30129.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60730.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30129.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29003.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":77861.06},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30129.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65660.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28158.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29285.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31312.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37169.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30129.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55588.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29848.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28158.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70322.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85435.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29566.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":79647.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":70322.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28158.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30129.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Cc","code_information":[{"code":"623","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14802.1,"maximum":74929.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26558.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47427.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15838.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45055.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31221.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47319.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31256.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33352.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15246.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15246.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28758.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53632.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74929.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32631.04},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39697.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42230.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15838.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30609.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15838.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15246.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39243.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15838.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33093.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14802.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15394.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16459.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19538.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15838.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29220.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15690.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14802.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35443.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43060.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15542.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40143.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35443.88},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14802.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15838.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":34842.62,"10th_percentile":34842.62,"90th_percentile":34842.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17375.16,"10th_percentile":17375.16,"90th_percentile":17375.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without Cc/Mcc","code_information":[{"code":"624","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10701.17,"maximum":52290.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18534.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33097.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11450.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31442.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21788.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33022.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21813.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23275.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11022.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11022.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20069.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37428.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52290.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22772.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":27703.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29470.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11450.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21361.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11450.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11022.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27386.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11450.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23095.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10701.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11129.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11899.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14125.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11450.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21125.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11343.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10701.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24735.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30050.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11236.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28015.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24735.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10701.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11450.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Mcc","code_information":[{"code":"625","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24079.88,"maximum":126146.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44712.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79845.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":75852.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":52561.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79664.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52622.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":56149.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24802.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24802.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":48415.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90291.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":126146.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":54935.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":66831.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71096.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":51531.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24802.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":66067.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55714.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24079.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25043.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26776.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31785.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25765.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47536.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25524.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24079.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59671.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72494.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25283.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":67583.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":59671.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24079.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25765.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures With Cc","code_information":[{"code":"626","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12573.82,"maximum":62628.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22198.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39641.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13453.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37658.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26095.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39551.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26125.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27876.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12951.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12951.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24036.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44827.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62628.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27274.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33180.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35297.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13453.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25584.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13453.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12951.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32800.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13453.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27660.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13076.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13982.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16597.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13453.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24821.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13328.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29625.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35991.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13202.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33553.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29625.15},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12573.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13453.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Thyroid, Parathyroid And Thyroglossal Procedures Without Cc/Mcc","code_information":[{"code":"627","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11279.23,"maximum":55481.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19665.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35117.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12068.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33361.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23117.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35037.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23144.3},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24695.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11617.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11617.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21293.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39712.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55481.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24161.78},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29393.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31269.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12068.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22664.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12068.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11617.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29057.89},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12068.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24504.48},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11279.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11730.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12542.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14888.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12068.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22266.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11955.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11279.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26244.55},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31884.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11843.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29724.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26244.55},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11279.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12068.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Mcc","code_information":[{"code":"628","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29426.98,"maximum":155664.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55175.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98529.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31486.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":93602.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":64861.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":98305.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":64935.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":69288.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30309.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30309.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":59744.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":111420.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":155664.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":67790.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":82470.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87732.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31486.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":63590.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31486.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30309.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":81527.48},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31486.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68752.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29426.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30604.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32722.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38843.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31486.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58091.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31192.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29426.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":73634.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89458.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30898.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":83398.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":73634.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29426.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31486.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures With Cc","code_information":[{"code":"629","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17714.36,"maximum":91006.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32257.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57603.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18954.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54722.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37919.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57472.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37963.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40508.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18245.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18245.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34928.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65139.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91006.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39632.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48214.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51291.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18954.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37176.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18954.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18245.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":47663.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18954.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40194.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18422.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19698.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23382.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18954.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34969.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18777.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43048.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52299.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18600.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48757.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43048.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17714.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18954.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":67844.3,"10th_percentile":67844.3,"90th_percentile":67844.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic O.R. Procedures Without Cc/Mcc","code_information":[{"code":"630","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12271.93,"maximum":60961.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21607.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38586.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13130.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36656.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25401.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38498.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25430.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27135.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12640.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12640.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23397.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43634.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60961.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26548.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32297.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34358.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13130.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24903.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13130.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12640.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31928.02},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13130.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26924.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12762.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13646.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16198.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13130.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24226.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13008.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12271.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28836.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35033.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12885.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32660.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28836.8},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12271.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13130.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Mcc","code_information":[{"code":"637","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12099.42,"maximum":60009.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21270.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37983.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12946.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36084.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25004.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37897.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25033.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26711.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12462.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12462.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23031.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42953.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60009.52},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26133.57},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31792.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33821.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12946.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24514.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12946.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12462.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31429.25},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12946.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26504.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12099.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12583.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13454.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15971.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12946.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23885.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12825.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12099.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28386.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34486.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12704.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32150.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28386.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12099.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12946.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12982.33,"10th_percentile":12982.33,"90th_percentile":12982.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11896.93,"10th_percentile":11896.93,"90th_percentile":11896.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13362.25,"10th_percentile":13362.25,"90th_percentile":15865.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4022.62,"10th_percentile":4022.62,"90th_percentile":4022.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4022.62,"10th_percentile":4022.62,"90th_percentile":4022.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With Cc","code_information":[{"code":"638","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8009.84,"maximum":37433.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13268.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23693.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8570.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22508.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15597.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23639.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15615.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16662.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8250.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8250.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14366.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26793.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37433.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16301.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19832.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21097.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8570.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15291.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8570.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8250.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19605.27},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8570.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16533.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8009.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8330.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8906.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10572.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8570.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15812.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8490.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8009.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17707.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21512.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8410.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20055.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17707.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8009.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8570.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":8426.51,"10th_percentile":8426.51,"90th_percentile":8426.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":14366.98,"10th_percentile":14366.98,"90th_percentile":14366.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8592.97,"10th_percentile":8592.97,"90th_percentile":8592.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2607.23,"10th_percentile":2607.23,"90th_percentile":2607.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10507.26,"10th_percentile":10507.26,"90th_percentile":10507.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without Cc/Mcc","code_information":[{"code":"639","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5929.11,"maximum":25946.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9196.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16423.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6344.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15602.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10811.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16386.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10823.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11549.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6106.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6106.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9958.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18572.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25946.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11299.63},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13746.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14623.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6344.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10599.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6344.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6106.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13589.37},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6344.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11459.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5929.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6166.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6593.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7826.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6344.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11704.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6284.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5929.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12273.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14911.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6225.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13901.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12273.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5929.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6344.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With Mcc","code_information":[{"code":"640","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11334.47,"maximum":55786.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19773.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35310.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12127.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33544.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23244.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35230.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23271.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24831.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11674.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11674.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21411.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39930.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55786.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24294.56},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29555.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31441.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12127.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22789.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12127.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11674.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29217.59},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12127.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24639.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11334.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11787.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12603.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14961.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12127.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22375.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12014.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11334.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26388.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32059.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11901.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29888.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26388.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11334.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12127.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12512.29,"10th_percentile":12512.29,"90th_percentile":12512.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3730.2,"10th_percentile":3730.2,"90th_percentile":3730.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11695.33,"10th_percentile":11695.33,"90th_percentile":11695.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7117.02,"maximum":32504.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11521.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20574.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7615.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19545.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13543.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20527.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13559.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14468.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7330.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7330.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12475.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23265.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32504.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14155.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17220.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18319.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7615.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13278.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7615.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7330.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17023.9},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7615.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14356.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7117.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7401.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7914.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9394.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7615.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14049.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7544.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7117.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15375.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18679.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7472.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17414.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15375.68},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7117.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7615.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":7482.0,"10th_percentile":7482.0,"90th_percentile":7482.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7856.77,"10th_percentile":7856.77,"90th_percentile":7856.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inborn And Other Disorders Of Metabolism","code_information":[{"code":"642","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11988.95,"maximum":59399.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21054.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37597.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12828.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35717.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24750.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37512.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24778.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26439.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12348.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12348.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22797.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42516.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59399.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25868.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31469.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33477.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12828.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24265.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12828.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12348.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31109.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12828.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26234.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11988.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12468.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13331.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15825.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12828.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23667.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12708.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11988.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28097.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34136.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12588.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31823.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28097.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11988.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12828.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Mcc","code_information":[{"code":"643","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13683.8,"maximum":68755.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24370.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43519.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14641.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41343.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28648.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43420.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28681.65},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30604.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14094.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14094.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26388.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49213.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68755.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29942.56},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36426.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38750.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14641.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28087.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14641.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14094.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36010.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14641.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30367.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13683.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14231.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15216.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18062.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14641.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27013.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14504.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13683.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32523.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39512.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14367.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36836.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32523.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13683.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14641.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders With Cc","code_information":[{"code":"644","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8984.38,"maximum":42813.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15175.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27098.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9613.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25743.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17839.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27037.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17859.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19056.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16431.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30644.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42813.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18644.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22682.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24129.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9613.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17489.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9613.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9253.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22422.9},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9613.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18909.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8984.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9343.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9990.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11859.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9613.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17736.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9523.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8984.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20251.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24604.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9433.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22937.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20251.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8984.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9613.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":8497.87,"10th_percentile":8497.87,"90th_percentile":8497.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7042.11,"maximum":32091.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11374.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20312.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7535.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19296.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13371.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20266.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13386.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14284.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12316.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22969.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32091.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13975.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17001.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18086.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7535.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13109.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7535.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7253.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16807.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7535.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14173.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7042.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7323.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7830.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9295.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7535.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13901.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7464.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7042.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15180.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18442.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7394.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17193.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15180.07},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7042.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7535.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With Mcc","code_information":[{"code":"650","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36801.08,"maximum":196372.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69604.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124295.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39377.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":118080.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":81823.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":124013.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":81917.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":87408.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37905.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37905.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":75368.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":140557.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":196372.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":85518.47},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":104037.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110675.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39377.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":80219.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39377.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37905.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":102847.83},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39377.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86731.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36801.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38273.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40922.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":48577.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39377.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72649.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39009.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36801.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":92890.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112852.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38641.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":105207.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":92890.26},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36801.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39377.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis Without Mcc","code_information":[{"code":"651","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29268.09,"maximum":154787.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54864.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97973.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31316.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":93074.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":64495.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":97751.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":64569.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":68898.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30146.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30146.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":59407.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":110792.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":154787.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":67408.5},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":82005.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87238.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31316.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":63232.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31316.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30146.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":81068.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31316.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68364.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30438.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32546.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38633.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31316.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57778.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31024.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":73219.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88954.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30731.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":82928.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":73219.2},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29268.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31316.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant","code_information":[{"code":"652","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25664.26,"maximum":134892.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47812.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85381.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":81112.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":56206.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":85187.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":56270.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60042.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26434.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26434.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51772.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":96552.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134892.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58744.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":71465.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76025.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55104.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26434.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":70648.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59577.82},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25664.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26690.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28538.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33876.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27460.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50663.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27204.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25664.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63808.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77520.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26947.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72269.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63808.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25664.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27460.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Mcc","code_information":[{"code":"653","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40546.4,"maximum":217048.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":76932.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137382.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43384.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":130512.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":90438.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":137070.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":90542.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":96611.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41762.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":41762.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":83303.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":155356.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":217048.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":94522.52},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":114991.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122328.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43384.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":88666.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43384.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41762.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":113676.45},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43384.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95863.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42168.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45087.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":53521.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43384.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":80042.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42979.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":102670.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124734.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42573.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":116285.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":102670.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43384.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With Cc","code_information":[{"code":"654","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22409.24,"maximum":116923.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41443.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74007.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":70307.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":48719.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":73839.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48775.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":52044.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23081.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23081.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":44875.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":83690.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":116923.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50919.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":61945.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65898.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47764.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23081.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":61237.49},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51641.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22409.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23305.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24919.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29580.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23977.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44238.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23753.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22409.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55308.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67194.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23529.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":62642.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":55308.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22409.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23977.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without Cc/Mcc","code_information":[{"code":"655","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17243.74,"maximum":88408.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31336.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55958.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18450.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53160.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36837.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55831.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36879.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39351.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17761.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17761.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33931.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63279.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88408.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38500.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46838.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49826.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18450.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36115.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18450.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17761.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46302.74},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18450.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39047.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17243.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17933.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19175.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22761.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18450.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34040.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18278.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17243.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41819.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50806.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18105.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47365.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41819.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17243.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18450.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Mcc","code_information":[{"code":"656","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25318.48,"maximum":132984.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47136.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84173.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27090.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":79964.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":55410.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83982.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55474.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59193.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26078.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26078.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51039.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":95186.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":132984.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57913.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":70454.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74949.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27090.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":54325.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27090.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26078.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":69648.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27090.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58734.74},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25318.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26331.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28154.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33420.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27090.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49981.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26837.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25318.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62905.52},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76423.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26584.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71247.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62905.52},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25318.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27090.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm With Cc","code_information":[{"code":"657","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15075.24,"maximum":76437.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27093.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48381.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45962.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31849.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48271.74},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31885.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34023.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15527.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15527.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29336.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54711.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76437.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33287.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40496.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43080.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31225.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15527.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40033.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33759.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15678.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16763.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19899.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16130.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29760.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15979.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36157.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43927.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15829.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40951.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36157.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15075.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16130.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without Cc/Mcc","code_information":[{"code":"658","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12970.3,"maximum":64817.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22974.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41026.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13878.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38975.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27007.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40933.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27038.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28851.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13359.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13359.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24876.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46394.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64817.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28227.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34339.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36530.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13878.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26478.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13878.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13359.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33947.18},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13878.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28627.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12970.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13489.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14422.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17120.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13878.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25604.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13748.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12970.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30660.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37249.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13618.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34726.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30660.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12970.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13878.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Mcc","code_information":[{"code":"659","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20454.12,"maximum":106130.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37618.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67176.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21885.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":63817.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44221.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67023.86},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44272.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47240.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21067.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21067.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40733.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75965.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":106130.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46218.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":56227.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59815.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21885.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43355.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21885.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21067.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":55584.73},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21885.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46874.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20454.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21272.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22744.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26999.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21885.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40378.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21681.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20454.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50203.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60991.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21476.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56860.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":50203.1},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20454.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21885.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11229.3,"maximum":55206.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19567.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34943.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12015.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33195.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23002.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34863.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23029.3},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24573.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11566.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11566.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21188.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39514.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55206.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24041.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29247.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31114.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12015.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22552.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12015.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11566.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28913.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12015.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24382.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11229.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11678.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12486.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14822.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12015.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22167.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11903.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11229.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26114.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31726.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11790.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29577.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26114.15},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11229.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12015.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9063.07,"maximum":43247.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15329.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27373.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9697.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26005.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18020.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27311.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18040.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19250.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9334.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9334.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16598.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30955.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43247.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18833.93},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22912.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24374.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9697.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17667.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9697.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9334.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22650.41},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9697.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19101.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9063.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9425.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10078.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11963.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9697.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17891.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9606.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9063.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20457.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24853.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9516.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23170.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20457.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9063.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9697.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11878.8,"10th_percentile":11878.8,"90th_percentile":11878.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Mcc","code_information":[{"code":"662","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24393.13,"maximum":127875.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":45325.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80939.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26100.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":76892.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":53282.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":80756.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":53343.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":56919.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25124.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25124.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":49078.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":91529.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":127875.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":55688.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":67747.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72070.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26100.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":52238.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26100.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25124.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":66973.37},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26100.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56478.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24393.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25368.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27125.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32198.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26100.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48154.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25856.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24393.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":60489.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73488.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25612.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":68510.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":60489.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24393.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26100.65,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With Cc","code_information":[{"code":"663","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12731.2,"maximum":63497.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22506.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40191.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38181.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26457.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40099.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26487.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28263.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13113.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13113.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24370.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45449.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63497.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27652.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33640.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35787.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25939.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13113.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33255.9},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28044.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12731.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13240.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14157.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16805.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25132.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13495.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12731.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30036.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36490.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13367.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34019.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30036.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12731.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13622.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures Without Cc/Mcc","code_information":[{"code":"664","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9150.08,"maximum":43727.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15499.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27677.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9790.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26293.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18220.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27615.13},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18241.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19463.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9424.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9424.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16782.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31299.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43727.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19043.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23166.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24645.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9790.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17863.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9790.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9424.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22901.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9790.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19313.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9150.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9516.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10174.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12078.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9790.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18063.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9699.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9150.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20684.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25129.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9607.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23427.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20684.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9150.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9790.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Mcc","code_information":[{"code":"665","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24844.83,"maximum":130369.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46209.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82518.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26583.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":78392.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":54321.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":82331.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54383.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58029.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25590.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25590.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50035.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":93314.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":130369.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":56774.63},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":69069.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73476.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26583.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":53257.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26583.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25590.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":68279.37},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26583.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57579.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24844.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25838.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27627.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32795.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26583.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49046.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26335.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24844.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61668.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74921.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26087.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":69846.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":61668.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24844.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26583.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy With Cc","code_information":[{"code":"666","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14464.64,"maximum":73066.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25898.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46247.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15477.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43935.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30444.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46143.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30479.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32522.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14898.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14898.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28043.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52298.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73066.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31819.77},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38710.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41180.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15477.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29848.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15477.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14898.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38267.69},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15477.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32271.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14464.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15043.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16084.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19093.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15477.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28554.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15332.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14464.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34562.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41990.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15187.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39145.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34562.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14464.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15477.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatectomy Without Cc/Mcc","code_information":[{"code":"667","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9598.76,"maximum":46204.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16377.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29245.72},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27783.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19252.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29179.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19274.43},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20566.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9886.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17733.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33072.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46204.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20121.78},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24479.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26041.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18875.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24199.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20407.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9982.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10673.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12670.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10270.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18948.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10174.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21856.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26553.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10078.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24754.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21856.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9598.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10270.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Mcc","code_information":[{"code":"668","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23322.5,"maximum":121965.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43230.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77198.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24955.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":73338.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50819.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77023.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50878.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54288.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24022.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24022.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46810.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":87299.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":121965.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53114.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":64616.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68739.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24955.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49823.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24955.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24022.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":63877.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24955.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53868.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23322.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24255.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25934.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30785.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24955.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46040.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24721.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23322.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57693.36},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70091.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24488.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65343.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57693.36},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23322.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24955.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures With Cc","code_information":[{"code":"669","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12971.81,"maximum":64825.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22977.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41031.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38980.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27011.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40938.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27042.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28854.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13360.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13360.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24880.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46400.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64825.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28230.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34344.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36535.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26481.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13360.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33951.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28631.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12971.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13490.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14424.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17122.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13879.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25607.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13750.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12971.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30664.42},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37254.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13620.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34730.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30664.42},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12971.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13879.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Procedures Without Cc/Mcc","code_information":[{"code":"670","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8623.46,"maximum":40820.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14468.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25837.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9227.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24545.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17008.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25779.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17028.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18169.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8882.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8882.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15667.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29218.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40820.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17777.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21626.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23006.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9227.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16675.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9227.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8882.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21379.41},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9227.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18029.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8968.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9589.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11382.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9227.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17023.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9140.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19309.49},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23459.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9054.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21870.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19309.49},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9227.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With Cc/Mcc","code_information":[{"code":"671","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14810.42,"maximum":74975.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26574.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47456.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15847.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45083.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31240.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47348.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31276.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33372.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15254.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15254.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28775.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53665.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74975.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32651.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39721.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42256.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15847.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30628.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15847.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15254.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39267.42},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15847.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33114.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14810.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15402.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16469.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19549.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15847.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29237.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15699.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14810.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35465.61},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43087.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15550.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40168.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35465.61},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14810.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15847.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without Cc/Mcc","code_information":[{"code":"672","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9396.74,"maximum":45089.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15982.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28539.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10054.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27112.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18787.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28475.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18809.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20070.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17305.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32273.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45089.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19636.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23888.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25412.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10054.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18419.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10054.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9678.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23615.14},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10054.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19914.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9396.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9772.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10449.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12403.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10054.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18550.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9960.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9396.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21328.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25912.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9866.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24157.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21328.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9396.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10054.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Mcc","code_information":[{"code":"673","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33019.45,"maximum":175496.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62204.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111081.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35330.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":105527.39},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":73124.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":110829.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":73208.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":78116.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67355.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":125615.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":175496.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":76427.1},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":92977.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98909.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35330.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71691.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35330.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34010.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":91914.2},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35330.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77511.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33019.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34340.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36717.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43585.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35330.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65183.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35000.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33019.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":83015.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100855.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34670.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":94023.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":83015.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33019.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35330.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18274.04,"10th_percentile":18274.04,"90th_percentile":18274.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20892.69,"10th_percentile":20892.69,"90th_percentile":20892.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With Cc","code_information":[{"code":"674","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18923.46,"maximum":97680.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34622.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61827.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20248.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":58736.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40700.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61687.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40747.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43479.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19491.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19491.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37490.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69917.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97680.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42539.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":51750.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55052.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20248.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39903.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20248.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19491.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":51159.21},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20248.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43142.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18923.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19680.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21042.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24978.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20248.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37356.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20058.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18923.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46206.06},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56135.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19869.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":52333.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":46206.06},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18923.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20248.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13648.24,"maximum":68559.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24300.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43395.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41225.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28566.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43296.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28599.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30516.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14057.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14057.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26313.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49072.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68559.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29857.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36322.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38640.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28007.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14057.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35907.27},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30280.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13648.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14194.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15176.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18015.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14603.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26942.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14467.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13648.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32430.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39400.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14330.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36731.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32430.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13648.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14603.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12434.61,"maximum":61859.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21926.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39154.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13305.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37196.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25775.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39065.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25804.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27534.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12807.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12807.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23741.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44277.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61859.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26939.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32773.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34864.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13305.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25270.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13305.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12807.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32398.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13305.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27321.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12434.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12931.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13827.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16413.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13305.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24547.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13180.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12434.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29261.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35549.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13056.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33141.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29261.6},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12434.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13305.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13730.67,"10th_percentile":12863.45,"90th_percentile":13735.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12830.88,"10th_percentile":12830.88,"90th_percentile":12830.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7855.49,"maximum":36581.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12966.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23154.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8405.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21996.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15242.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23101.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15259.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16282.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8091.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8091.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14039.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26183.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36581.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15930.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19380.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20617.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8405.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14943.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8405.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8091.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19159.0},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8405.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16156.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7855.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8169.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8735.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10369.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8405.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15507.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8326.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7855.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17304.06},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21022.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8248.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19598.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17304.06},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7855.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8405.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":8258.75,"10th_percentile":8258.75,"90th_percentile":8258.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8678.01,"10th_percentile":8678.01,"90th_percentile":8678.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5770.97,"maximum":25073.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8887.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15870.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15077.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10447.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15834.71},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10459.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11160.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5944.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5944.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9623.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17947.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25073.93},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10919.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13284.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14131.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10242.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5944.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13132.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11074.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5770.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6001.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6417.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7617.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6174.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11392.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6117.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5770.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11860.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14409.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6059.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13433.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11860.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5770.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6174.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Mcc","code_information":[{"code":"686","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14876.25,"maximum":75338.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26703.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47686.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15917.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45301.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31391.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47578.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31427.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33534.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15322.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15322.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28915.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53925.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75338.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32809.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39914.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42460.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15917.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30776.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15917.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15322.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39457.74},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15917.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33274.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14876.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15471.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16542.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19636.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15917.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29367.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15768.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14876.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35637.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43296.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15620.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40363.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35637.5},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14876.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15917.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With Cc","code_information":[{"code":"687","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9156.89,"maximum":43765.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15512.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27701.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9797.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26316.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18235.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27638.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18256.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19480.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9431.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9431.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16797.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31326.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43765.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19059.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23186.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24666.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9797.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17878.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9797.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9431.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22921.67},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9797.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19329.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9523.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10182.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12087.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9797.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18076.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9706.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20702.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25151.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9614.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23447.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20702.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9156.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9797.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7208.57,"maximum":33010.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11700.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20893.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7713.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19849.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13754.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20846.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13770.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14693.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7424.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7424.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12669.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23627.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33010.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14375.56},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17488.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18604.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7713.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13484.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7713.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7424.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17288.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7713.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14579.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7208.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7496.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8015.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9515.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7713.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14230.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7641.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7208.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15614.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18970.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7569.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17685.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15614.75},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7208.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7713.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis With Cc Or High Dose Chemotherapy Agent","code_information":[{"code":"838","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17022.8,"maximum":87188.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30903.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55186.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18214.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52427.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36329.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55061.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36370.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38808.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17533.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17533.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33463.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62407.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87188.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37969.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46192.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49139.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18214.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35617.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18214.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17533.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45663.96},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18214.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38508.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17022.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17703.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18929.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22470.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18214.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33604.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18044.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17022.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41242.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50105.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17873.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46711.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41242.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17022.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18214.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"839","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12153.9,"maximum":60310.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21376.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38173.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13004.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36264.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25129.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38087.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25158.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26844.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12518.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12518.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23147.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43168.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60310.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26264.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31952.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33990.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13004.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24637.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13004.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12518.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31586.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13004.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26637.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12153.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12640.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13515.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16043.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13004.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23993.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12883.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12153.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28528.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34659.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12761.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32311.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28528.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12153.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13004.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Mcc","code_information":[{"code":"840","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25705.12,"maximum":135118.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47892.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85524.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27504.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":81247.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":56300.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":85330.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":56364.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60143.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26476.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26476.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51858.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":96713.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":135118.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58842.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":71585.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76152.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27504.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55197.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27504.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26476.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":70766.67},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27504.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59677.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25705.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26733.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28584.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33930.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27504.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50744.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27247.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25705.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63915.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77650.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26990.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72390.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63915.15},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25705.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27504.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Cc","code_information":[{"code":"841","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13572.58,"maximum":68141.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24152.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43130.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14522.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40974.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28392.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43033.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28425.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30330.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13979.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13979.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26152.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48773.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68141.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29675.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36101.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38404.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14522.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27836.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14522.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13979.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35688.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14522.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30096.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13572.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14115.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15092.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17915.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14522.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26793.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14386.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13572.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32233.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39160.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14251.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36507.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32233.2},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13572.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14522.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity Without Major Problems","code_information":[{"code":"792","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19760.29,"maximum":102300.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36260.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64751.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61514.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42625.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64605.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42674.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45535.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20353.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20353.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39263.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73223.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":102300.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44550.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":54198.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57656.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41790.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20353.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":53578.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45182.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19760.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20550.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21973.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26083.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21143.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39008.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20945.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19760.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48391.29},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58790.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20748.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":54808.2},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48391.29},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19760.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21143.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major Problems","code_information":[{"code":"793","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32777.33,"maximum":174160.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61730.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110235.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35071.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":104723.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":72567.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":109985.71},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":72651.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":77521.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33760.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33760.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":66842.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":124658.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":174160.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":75845.02},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":92269.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98156.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35071.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71145.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35071.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33760.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":91214.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35071.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76920.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32777.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34088.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36448.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43266.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35071.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64705.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34743.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32777.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":82382.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100087.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34416.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":93307.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":82382.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32777.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35071.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without Cc/Mcc","code_information":[{"code":"712","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9549.58,"maximum":45933.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16281.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29073.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10218.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27620.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19139.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29007.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19161.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20445.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17629.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32877.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45933.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20003.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24335.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25888.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10218.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18764.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10218.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9836.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24057.04},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10218.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20287.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9549.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9931.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10619.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12605.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10218.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18851.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10122.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9549.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21727.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26397.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10027.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24609.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21727.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9549.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10218.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With Cc/Mcc","code_information":[{"code":"713","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12604.09,"maximum":62795.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22257.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39746.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13486.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37759.39},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26165.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39656.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26195.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27951.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12982.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12982.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24101.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44947.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62795.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27346.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33268.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35391.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13486.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25652.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13486.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12982.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32888.38},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13486.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27734.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12604.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13108.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14015.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16637.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13486.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24881.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13360.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12604.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29704.18},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36087.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13234.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33643.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29704.18},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12604.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13486.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy Without Cc/Mcc","code_information":[{"code":"714","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9229.52,"maximum":44166.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15654.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27955.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9875.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26557.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18402.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27892.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18424.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19659.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9506.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9506.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16951.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31613.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44166.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19234.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23399.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24892.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9875.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18042.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9875.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9506.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23131.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9875.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19506.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9229.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9598.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10263.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12182.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9875.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18220.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9783.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9229.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20892.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25381.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9691.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23662.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20892.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9229.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9875.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy With Cc/Mcc","code_information":[{"code":"715","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18156.99,"maximum":93449.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33123.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59149.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19427.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":56192.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38937.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59015.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38982.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41595.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18701.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18701.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35866.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66888.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93449.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40696.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":49509.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52668.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19427.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38175.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19427.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18701.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":48943.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19427.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41273.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18156.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18883.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20190.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23967.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19427.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35843.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19246.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18156.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44204.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53704.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19064.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50066.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44204.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18156.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19427.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures For Malignancy Without Cc/Mcc","code_information":[{"code":"716","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12358.94,"maximum":61442.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21778.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38890.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13224.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36945.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25601.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38802.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25630.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27348.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23581.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43978.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61442.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26757.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32551.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34628.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13224.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25099.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13224.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12729.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32179.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13224.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27137.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12358.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12853.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13743.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16313.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13224.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24397.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13100.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12358.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29064.02},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35309.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12976.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32918.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29064.02},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12358.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13224.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy With Cc/Mcc","code_information":[{"code":"717","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15533.0,"maximum":78964.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27988.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49981.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47481.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32902.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49867.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32940.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35148.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15998.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15998.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30306.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56520.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78964.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34388.2},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":41834.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44504.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32257.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15998.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":41356.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34875.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15533.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16154.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17272.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20503.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30663.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16464.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15533.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37352.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45379.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16309.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42305.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37352.5},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15533.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16620.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System O.R. Procedures Except Malignancy Without Cc/Mcc","code_information":[{"code":"718","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11391.21,"maximum":56099.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19884.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35508.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12188.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33733.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23375.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35428.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23402.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24970.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11732.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11732.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21531.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40154.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56099.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24430.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29721.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31617.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12188.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22917.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12188.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11732.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29381.66},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12188.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24777.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11391.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11846.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12667.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15036.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12188.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22487.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12074.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11391.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26536.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32239.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11960.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30055.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26536.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11391.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12188.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Mcc","code_information":[{"code":"722","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14921.64,"maximum":75589.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26792.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47844.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15966.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45452.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31496.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47736.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31532.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33645.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15369.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15369.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29011.3},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54104.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75589.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32918.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40046.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42602.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15966.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30878.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15966.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15369.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39589.0},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15966.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33385.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14921.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15518.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16592.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19696.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15966.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29456.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15816.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14921.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35756.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43440.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15667.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40497.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35756.05},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14921.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15966.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With Cc","code_information":[{"code":"723","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9874.93,"maximum":47729.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16917.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30210.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10566.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28700.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19887.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30142.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19910.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21245.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10171.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10171.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18318.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34163.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47729.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20785.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25286.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26900.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10566.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19497.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10566.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10171.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24997.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10566.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21080.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9874.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10269.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10980.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13034.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10566.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19494.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10467.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9874.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22577.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27429.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10368.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25571.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22577.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9874.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10566.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without Cc/Mcc","code_information":[{"code":"724","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6190.15,"maximum":27387.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9707.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17335.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16468.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11411.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17296.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11424.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12190.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6375.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6375.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10511.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19603.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27387.93},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11927.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14509.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15435.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11188.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6375.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14344.09},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12096.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6190.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6437.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6883.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8171.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6623.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12219.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6561.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6190.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12955.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15739.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6499.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14673.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12955.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6190.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6623.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy With Mcc","code_information":[{"code":"725","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10083.0,"maximum":48878.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17324.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30937.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10788.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29390.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20366.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30867.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20389.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21756.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10385.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10385.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18759.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34985.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48878.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21285.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25895.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27547.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10788.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19967.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10788.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10385.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25599.3},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10788.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21587.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10083.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10486.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11212.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13309.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10788.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19904.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10687.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10083.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23120.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28089.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10587.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26186.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23120.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10083.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10788.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11137.32,"10th_percentile":11137.32,"90th_percentile":11137.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Benign Prostatic Hypertrophy Without Mcc","code_information":[{"code":"726","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6691.79,"maximum":30157.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10689.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19088.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18133.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12565.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19044.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12580.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13423.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6892.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6892.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11574.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21585.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30157.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13133.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15977.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16996.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12319.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6892.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15794.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13319.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6959.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7441.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8833.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7160.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13210.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7093.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14265.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17330.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7026.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16156.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14265.28},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6691.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7160.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12448.98,"maximum":61939.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21954.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39204.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13320.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37244.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25808.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39115.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25838.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27570.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12822.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12822.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23772.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44334.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61939.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26973.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32815.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34908.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13320.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25302.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13320.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12822.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32439.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13320.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27356.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12448.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12946.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13843.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16432.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13320.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24575.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13195.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12448.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29299.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35595.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13071.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33184.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29299.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12448.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13320.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System Without Mcc","code_information":[{"code":"728","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7366.7,"maximum":33883.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12009.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21446.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7882.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20374.1},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14118.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21397.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14134.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15081.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7587.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7587.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13004.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24252.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33883.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14755.73},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17951.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19096.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7882.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13841.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7882.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7587.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17745.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7882.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14965.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7366.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7661.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8191.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9724.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7882.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14542.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7808.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7366.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16027.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19472.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7735.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18153.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16027.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7366.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7882.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses With Cc/Mcc","code_information":[{"code":"729","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9239.36,"maximum":44220.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15674.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27989.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26590.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18425.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27926.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18446.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19683.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9516.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9516.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16972.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31651.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44220.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19257.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23427.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24922.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18064.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9516.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23160.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19530.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9239.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9608.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10274.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12195.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9886.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18239.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9793.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9239.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20917.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25413.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9701.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23691.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20917.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9239.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9886.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6313.48,"maximum":28068.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9948.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17766.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16877.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11695.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17726.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11708.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12493.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6502.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10772.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20090.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28068.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12223.68},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14870.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15819.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11466.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14700.67},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6755.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12397.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6566.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8333.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6755.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12463.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13277.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16130.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6629.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15038.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13277.38},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6313.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy With Cc/Mcc","code_information":[{"code":"734","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17345.13,"maximum":88967.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31534.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56312.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53497.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37070.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56185.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37113.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39600.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17865.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17865.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34146.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63680.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88967.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38744.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":47134.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50142.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36344.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17865.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46595.88},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39294.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17345.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18038.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19287.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22895.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18559.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34241.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18385.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17345.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42084.54},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51128.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18212.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47665.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42084.54},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17345.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18559.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pelvic Evisceration, Radical Hysterectomy And Radical Vulvectomy Without Cc/Mcc","code_information":[{"code":"735","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11409.37,"maximum":56200.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19920.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35572.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12208.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33793.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23417.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35491.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23443.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25015.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11751.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11751.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21569.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40226.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56200.19},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24474.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29774.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31674.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12208.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22958.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12208.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11751.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29434.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12208.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24821.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11409.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11865.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12687.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15060.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12208.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22523.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12093.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11409.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26584.39},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32297.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11979.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30109.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26584.39},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11409.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12208.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28274.63,"maximum":149303.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52920.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94502.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30253.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89777.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62210.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":94288.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62282.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":66457.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29122.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29122.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57302.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":106866.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":149303.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65020.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":79100.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84147.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30253.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60991.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30253.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29122.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":78195.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30253.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65942.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28274.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29405.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31441.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37322.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30253.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55816.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29971.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28274.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70624.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85802.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29688.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":79990.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":70624.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28274.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30253.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Cc","code_information":[{"code":"737","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16820.03,"maximum":86069.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30507.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54478.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17997.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":51754.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35862.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54354.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35903.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38310.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17324.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17324.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33033.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61605.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86069.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37482.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":45599.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48508.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17997.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35160.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17997.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17324.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45077.69},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17997.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38013.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16820.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17492.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18703.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22202.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17997.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33204.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17829.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16820.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40713.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49462.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17661.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46112.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40713.33},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16820.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17997.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"738","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12340.03,"maximum":61337.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21741.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38824.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13203.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36882.85},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25557.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38736.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25587.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27302.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12710.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12710.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23541.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43903.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61337.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26712.02},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32496.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34569.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13203.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25057.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13203.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12710.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32124.91},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13203.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27090.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12340.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12833.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13722.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16288.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13203.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24360.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13080.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12340.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29014.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35249.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12957.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32862.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29014.62},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12340.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13203.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Mcc","code_information":[{"code":"739","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28337.43,"maximum":149649.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53043.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94722.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30321.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":89985.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62355.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":94507.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62426.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":66611.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29187.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29187.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57435.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":107114.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":149649.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65171.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":79283.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84342.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30321.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":61133.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30321.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29187.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":78377.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30321.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66095.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28337.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29470.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31511.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37405.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30321.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55940.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30037.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28337.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":70788.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86001.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29754.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":80175.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":70788.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28337.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30321.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With Cc","code_information":[{"code":"740","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14920.89,"maximum":75585.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26791.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47842.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15965.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45449.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31494.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47733.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31530.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33644.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15368.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15368.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29009.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54101.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75585.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32916.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40044.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42599.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15965.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30877.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15965.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15368.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39586.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15965.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33383.5},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14920.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15517.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16592.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19695.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15965.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29455.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15816.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14920.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35754.08},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43437.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15666.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40495.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35754.08},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14920.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15965.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without Cc/Mcc","code_information":[{"code":"741","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12019.22,"maximum":59566.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21113.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37703.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12860.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35817.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24819.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37617.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24848.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26514.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12379.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12379.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22861.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42636.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59566.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25940.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31558.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33571.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12860.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24333.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12860.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12379.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31197.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12860.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26308.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12019.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12499.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13365.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15865.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12860.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23727.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12740.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12019.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28176.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34232.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12620.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31913.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28176.88},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12019.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12860.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With Cc/Mcc","code_information":[{"code":"742","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15111.56,"maximum":76637.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27164.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48508.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16169.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46082.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31932.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48398.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31969.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34112.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15564.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15564.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29413.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54855.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76637.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33375.01},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40602.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43193.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16169.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31307.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16169.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15564.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40138.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16169.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33848.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15111.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15716.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16804.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19947.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16169.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29831.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16018.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15111.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36251.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44042.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15867.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41059.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36251.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15111.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16169.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without Cc/Mcc","code_information":[{"code":"743","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10616.43,"maximum":51822.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18368.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32801.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31161.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21593.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32727.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21617.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23067.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10934.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10934.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19889.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37093.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51822.8},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22568.33},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":27455.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29207.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21170.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10934.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27141.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22888.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10616.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11041.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11805.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14013.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11359.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20957.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11253.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10616.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24513.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29781.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11147.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27764.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24513.75},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10616.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11359.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With Cc/Mcc","code_information":[{"code":"744","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16733.01,"maximum":85588.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30336.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54174.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17904.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":51465.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35662.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54051.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35703.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38096.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17235.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17235.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32849.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61261.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":85588.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37273.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":45344.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48237.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17904.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34963.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17904.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17235.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":44826.11},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17904.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37801.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16733.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17402.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18607.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22087.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17904.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33032.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17736.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16733.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40486.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49186.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17569.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45854.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40486.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16733.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17904.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonate With Other Significant Problems","code_information":[{"code":"794","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12396.02,"maximum":61646.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21850.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39019.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13263.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37068.7},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25686.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38931.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25716.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27439.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12767.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12767.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23660.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44124.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61646.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26846.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32660.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34744.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13263.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25183.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13263.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12767.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32286.79},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13263.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27227.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12396.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12891.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13784.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16362.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13263.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24470.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13139.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12396.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29160.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35427.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13015.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33027.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29160.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12396.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13263.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":2740.67,"maximum":8345.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":2958.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5282.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2932.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":5018.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":3477.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":5270.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":3481.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":3714.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2822.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":2822.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":3202.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":5973.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":8345.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":3634.36},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":4421.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4703.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2932.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":3409.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2932.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2822.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":4370.82},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2932.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3685.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2850.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3047.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":3617.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2932.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5410.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2905.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":3947.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4796.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2877.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":4471.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":3947.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2740.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2932.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10058.79,"maximum":48744.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17277.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30853.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10762.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29310.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20310.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30783.13},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20333.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21696.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10360.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10360.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18708.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34889.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48744.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21227.73},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25824.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27472.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10762.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19912.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10762.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10360.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25529.29},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10762.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21528.82},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10058.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10461.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11185.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13277.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10762.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19857.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10662.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10058.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23057.59},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28012.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10561.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26115.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23057.59},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10058.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10762.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Cc","code_information":[{"code":"797","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8798.25,"maximum":41785.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14810.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26448.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9414.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25126.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17410.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26388.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17430.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18599.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9062.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9062.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16037.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29908.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41785.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18197.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22137.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23550.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9414.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17069.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9414.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9062.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21884.75},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9414.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18455.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8798.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9783.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11613.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9414.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17368.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9326.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8798.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19765.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24013.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9238.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22386.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19765.9},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8798.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9414.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10008.1,"maximum":48464.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17178.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30676.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10708.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29142.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20193.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30606.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20217.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21572.3},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10308.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10308.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18600.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34689.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48464.57},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21105.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25676.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27314.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10708.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19798.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10708.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10308.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25382.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10708.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21405.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10008.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10408.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11129.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13210.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10708.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19756.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10608.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10008.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22925.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27851.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10508.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25965.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22925.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10008.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10708.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":18434.86,"10th_percentile":18434.86,"90th_percentile":18434.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9010.37,"10th_percentile":9010.37,"90th_percentile":11047.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10537.01,"10th_percentile":10537.01,"90th_percentile":10537.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7353.84,"maximum":33812.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11984.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21401.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7868.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20331.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14088.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21352.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14104.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15050.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7574.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7574.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12977.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24201.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33812.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14724.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17913.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19056.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7868.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13812.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7868.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7574.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17708.62},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7868.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14933.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7353.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7647.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8177.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9707.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7868.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14517.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7795.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7353.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15994.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19431.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7721.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18114.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15994.1},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7353.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7868.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":8124.04,"10th_percentile":8116.54,"90th_percentile":9645.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2655.36,"10th_percentile":2655.36,"90th_percentile":2655.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2630.31,"10th_percentile":2630.31,"90th_percentile":2630.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":500.0,"10th_percentile":500.0,"90th_percentile":500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2630.31,"10th_percentile":2630.31,"90th_percentile":2630.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5753.99,"10th_percentile":5753.99,"90th_percentile":5753.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones With Mcc","code_information":[{"code":"693","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11401.81,"maximum":56158.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19905.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35545.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12199.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33768.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23399.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35465.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23426.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24996.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11743.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11743.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21553.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40196.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56158.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24456.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29752.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31650.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12199.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22941.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12199.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11743.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29412.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12199.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24803.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11401.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11857.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12678.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15050.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12199.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22508.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12085.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11401.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26564.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32273.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11971.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30087.22},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26564.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11401.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12199.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":35465.22,"10th_percentile":35465.22,"90th_percentile":35465.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones Without Mcc","code_information":[{"code":"694","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7143.5,"maximum":32650.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11573.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20666.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7643.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19633.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13604.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20619.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13620.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14533.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7357.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7357.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12531.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23370.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32650.83},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14219.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17298.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18402.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7643.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13338.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7643.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7357.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17100.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7643.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14420.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7429.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7943.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9429.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7643.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14101.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7572.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15444.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18763.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7500.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17492.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15444.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7143.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7643.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":14212.57,"10th_percentile":14212.57,"90th_percentile":14212.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With Mcc","code_information":[{"code":"695","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9883.25,"maximum":47775.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16933.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30239.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28727.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19906.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30171.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19929.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21265.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10179.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10179.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18336.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34196.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47775.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20805.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25311.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26926.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19516.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10179.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25021.77},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21100.82},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9883.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10278.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10990.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13045.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10575.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19510.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10476.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9883.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22599.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27455.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10377.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25595.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22599.2},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9883.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10575.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms Without Mcc","code_information":[{"code":"696","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6442.1,"maximum":28778.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10200.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18215.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6893.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17304.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11991.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18174.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12005.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12809.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6635.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6635.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11045.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20599.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28778.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12532.91},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15246.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16219.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6893.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11756.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6893.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6635.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15072.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6893.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12710.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6442.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6699.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7163.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8503.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6893.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12717.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6828.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6442.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13613.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16538.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6764.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15418.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13613.26},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6442.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6893.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4994.21,"10th_percentile":4994.21,"90th_percentile":4994.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9383.88,"maximum":45018.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15956.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28494.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10040.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27070.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18758.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28430.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18779.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20038.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9665.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9665.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17278.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32222.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45018.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19605.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23850.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25372.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10040.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18390.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10040.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9665.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23577.95},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10040.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19883.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9383.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9759.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10434.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12386.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10040.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18524.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9946.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9383.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21295.17},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25871.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9853.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24119.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21295.17},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9383.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10040.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Mcc","code_information":[{"code":"698","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13746.6,"maximum":69102.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24493.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43739.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14708.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41551.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28793.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43639.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28826.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30758.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14159.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14159.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26521.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49461.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69102.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30093.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36610.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38946.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14708.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28229.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14708.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14159.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36191.65},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14708.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30520.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13746.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14296.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15286.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18145.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14708.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27137.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14571.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13746.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32687.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39712.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14433.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37022.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32687.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13746.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14708.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4659.74,"10th_percentile":4659.74,"90th_percentile":4659.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With Cc","code_information":[{"code":"699","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8908.71,"maximum":42395.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15027.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26834.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25492.74},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17665.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26773.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17685.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18870.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9175.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9175.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16271.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30345.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42395.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18462.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22460.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23894.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17318.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9175.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22204.14},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18724.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8908.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9265.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9906.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11759.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9532.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17586.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9443.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8908.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20054.37},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24364.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9354.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22713.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20054.37},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8908.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9532.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2943.86,"10th_percentile":2943.86,"90th_percentile":2943.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6448.91,"maximum":28816.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10213.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18239.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6900.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17327.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12007.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18198.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12020.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12826.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6642.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6642.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11059.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20625.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28816.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12549.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15266.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16240.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6900.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11771.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6900.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6642.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15092.25},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6900.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12727.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6448.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6706.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7171.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8512.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6900.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6835.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6448.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13631.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16560.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6771.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15438.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13631.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6448.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6900.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures With Cc/Mcc","code_information":[{"code":"707","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16363.78,"maximum":83550.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29614.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52883.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17509.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50239.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34813.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52763.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34853.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37189.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16854.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16854.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32066.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59802.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83550.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36385.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44264.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47089.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17509.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34131.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17509.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16854.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43758.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17509.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36901.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16363.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17018.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18196.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21600.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17509.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32303.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17345.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16363.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39521.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48015.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17181.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44762.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39521.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16363.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17509.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Male Pelvic Procedures Without Cc/Mcc","code_information":[{"code":"708","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12837.13,"maximum":64082.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22713.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40561.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13735.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38532.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26701.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40469.13},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26731.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28523.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13222.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13222.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24594.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45867.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64082.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27907.1},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33950.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36116.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13735.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26178.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13735.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13222.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33562.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13735.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28302.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12837.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13350.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14274.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16945.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13735.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25341.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13607.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12837.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30312.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36826.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13478.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34332.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30312.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12837.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13735.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures With Cc/Mcc","code_information":[{"code":"709","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18836.44,"maximum":97200.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34452.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61523.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20154.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":58447.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40500.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61384.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40547.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43265.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19401.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19401.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37305.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69573.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97200.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42329.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":51496.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54782.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20154.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39707.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20154.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19401.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":50907.64},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20154.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42930.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18836.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19589.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20946.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24864.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20154.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37185.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19966.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18836.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45978.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55859.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19778.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":52075.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45978.84},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18836.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20154.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penis Procedures Without Cc/Mcc","code_information":[{"code":"710","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11830.82,"maximum":58526.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20744.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37044.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35192.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24386.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36960.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24414.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26051.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12185.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12185.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22462.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41891.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58526.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25487.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31007.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32985.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23908.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12185.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30652.65},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12658.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25849.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11830.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12304.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13155.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15616.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12658.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23355.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12540.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11830.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27684.91},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33634.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12422.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31356.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27684.91},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11830.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With Cc/Mcc","code_information":[{"code":"711","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16995.56,"maximum":87038.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30850.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55091.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18185.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52336.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36266.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54966.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36308.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38742.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17505.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17505.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33405.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62299.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87038.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37904.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46112.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49054.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18185.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35555.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18185.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17505.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45585.21},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18185.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38441.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16995.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17675.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18899.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22434.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18185.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33550.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18015.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16995.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41171.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50019.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17845.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46631.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41171.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16995.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18185.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without Cc/Mcc","code_information":[{"code":"798","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8470.63,"maximum":39977.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14169.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25303.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24038.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16657.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25246.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16676.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17794.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8724.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8724.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15343.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28614.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39977.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17409.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21179.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22531.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16331.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8724.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20937.52},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17656.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8470.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8809.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9419.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11181.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9063.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16721.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8978.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8470.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18910.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22974.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8894.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21417.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18910.38},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8470.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9063.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Mcc","code_information":[{"code":"799","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35495.9,"maximum":189167.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67050.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119735.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37980.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":113747.85},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":78820.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":119463.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":78911.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":84201.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36560.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36560.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":72602.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":135400.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":189167.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":82380.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":100220.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106614.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37980.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":77276.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37980.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36560.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":99074.22},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37980.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83549.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35495.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36915.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39471.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46854.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37980.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70072.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37625.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35495.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":89482.01},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108711.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37270.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":101347.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":89482.01},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35495.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37980.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With Cc","code_information":[{"code":"800","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22485.66,"maximum":117345.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41593.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74274.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24059.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":70560.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":48894.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":74106.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48950.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":52232.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23160.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23160.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":45037.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":83992.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":117345.83},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":51102.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":62169.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66136.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24059.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47936.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24059.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23160.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":61458.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24059.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51827.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22485.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23385.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25004.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29681.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24059.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44388.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23834.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22485.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55508.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67436.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23609.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":62868.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":55508.13},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22485.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24059.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures Without Cc/Mcc","code_information":[{"code":"801","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15672.22,"maximum":79732.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28261.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50467.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47943.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33222.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50352.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33260.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35490.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16142.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16142.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30601.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57070.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79732.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34722.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42242.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44937.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32571.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16142.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":41759.1},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35215.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15672.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16299.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17427.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20687.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16769.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30938.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16612.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15672.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37716.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45821.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16455.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42717.36},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37716.05},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15672.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16769.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Mcc","code_information":[{"code":"802","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31373.78,"maximum":166411.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":58984.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105331.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":100064.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":69339.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":105092.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":69418.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":74072.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32314.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32314.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":63869.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":119112.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":166411.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":72470.78},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":88164.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93789.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":67980.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32314.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":87156.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73498.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31373.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32628.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34887.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":41413.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33569.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":61934.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33256.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31373.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":78717.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95634.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32942.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":89156.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":78717.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31373.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33569.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs With Cc","code_information":[{"code":"803","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15293.91,"maximum":77644.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27521.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49145.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46688.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32352.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49034.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32389.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34560.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15752.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15752.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29800.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55575.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77644.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33813.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":41135.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43760.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31718.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15752.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40665.3},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34292.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15293.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15905.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17006.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20187.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30191.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16211.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15293.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36728.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44621.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16058.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41598.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36728.15},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15293.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures Of The Blood And Blood Forming Organs Without Cc/Mcc","code_information":[{"code":"804","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11488.82,"maximum":56638.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20075.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35849.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12293.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34057.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23599.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35768.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23626.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25210.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11833.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11833.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21738.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40540.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56638.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24665.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30006.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31921.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12293.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23137.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12293.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11833.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29663.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12293.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25015.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11488.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11948.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12775.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15165.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12293.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22680.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12178.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11488.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26791.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32549.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12063.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30344.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26791.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11488.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12293.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Mcc","code_information":[{"code":"805","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9394.47,"maximum":45077.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15977.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28531.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10052.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27105.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18782.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28467.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18803.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20064.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9676.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9676.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17300.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32264.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45077.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19630.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23881.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25405.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10052.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18414.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10052.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9676.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23608.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10052.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19909.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9394.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9770.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10446.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12400.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10052.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18545.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9958.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9394.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21322.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25905.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9864.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24150.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21322.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9394.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10052.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With Cc","code_information":[{"code":"806","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6933.91,"maximum":31493.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11162.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19934.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7419.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18937.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13122.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19889.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13137.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14018.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7141.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7141.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12087.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22542.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31493.83},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13715.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16685.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17749.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7419.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12865.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7419.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7141.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16494.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7419.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13909.79},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7211.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7710.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9152.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7419.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13688.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7349.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14897.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18099.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7280.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16873.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14897.53},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6933.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7419.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without Cc/Mcc","code_information":[{"code":"807","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6330.12,"maximum":28160.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9981.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17824.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6773.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16933.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11733.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17784.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11747.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12534.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6520.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6520.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10808.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20156.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28160.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12263.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14919.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15871.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6773.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11503.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6773.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6520.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14748.8},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6773.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12437.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6330.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6583.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7039.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8355.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6773.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12496.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6709.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6330.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13320.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16183.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6646.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15087.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13320.84},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6330.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6773.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"808","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17934.54,"maximum":92221.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32687.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58372.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19189.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":55453.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38426.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58239.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38470.45},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41049.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35394.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66009.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":92221.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40161.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48858.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51976.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19189.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37673.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19189.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18472.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":48300.02},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19189.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40731.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17934.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18651.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19943.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23673.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19189.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35404.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19010.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17934.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43623.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52998.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18831.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49408.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43623.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17934.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19189.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17190.55,"10th_percentile":17190.55,"90th_percentile":17190.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"809","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10807.1,"maximum":52875.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18741.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33467.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11563.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31794.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22031.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33391.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22057.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23535.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11131.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11131.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20293.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37846.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":52875.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23026.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28013.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29800.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11563.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21600.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11563.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11131.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27692.83},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11563.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23353.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11239.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12017.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14265.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11563.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21334.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11455.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25011.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30386.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11347.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28328.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25011.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10807.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11563.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":11369.38,"10th_percentile":11369.38,"90th_percentile":11369.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11929.93,"10th_percentile":11929.93,"90th_percentile":11929.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders ","code_information":[{"code":"810","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9147.81,"maximum":43715.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15494.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27670.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9788.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26286.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18215.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27607.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18235.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19458.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9422.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9422.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16778.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31290.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43715.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19037.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23160.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24638.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9788.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17858.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9788.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9422.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22895.42},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9788.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19307.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9147.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9513.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10172.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12075.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9788.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18058.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9696.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9147.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20678.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25122.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9605.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23420.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20678.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9147.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9788.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With Mcc","code_information":[{"code":"811","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11854.27,"maximum":58656.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20790.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37126.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12684.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35270.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24440.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37042.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24468.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26108.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12209.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12209.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22512.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41984.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58656.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25544.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31075.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33058.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12684.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23961.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12684.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12209.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30720.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12684.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25906.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11854.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12328.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13181.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15647.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12684.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23401.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12565.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11854.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27746.16},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33708.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12446.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31425.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27746.16},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11854.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12684.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":23443.7,"10th_percentile":23443.7,"90th_percentile":23443.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13086.3,"10th_percentile":13086.3,"90th_percentile":13086.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8176.3,"maximum":38352.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13593.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24275.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8748.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23061.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15980.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24220.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15998.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17071.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8421.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8421.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14719.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27451.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38352.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16702.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20318.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21615.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8748.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15667.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8748.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8421.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20086.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8748.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16938.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8176.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8503.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9092.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10792.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8748.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16140.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8666.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8176.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18141.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22040.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8585.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20547.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18141.8},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8176.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8748.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":13593.95,"10th_percentile":13593.95,"90th_percentile":13593.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6059.65,"10th_percentile":6059.65,"90th_percentile":6059.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12769.79,"maximum":63710.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22582.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40325.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38309.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26546.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40234.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26576.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28358.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13152.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13152.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24452.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45601.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63710.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27745.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33753.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35907.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26026.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13152.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33367.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28138.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12769.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13280.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14200.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16856.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13663.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25208.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13535.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12769.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30136.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36613.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13408.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34133.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30136.88},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12769.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13663.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":13435.83,"10th_percentile":13435.83,"90th_percentile":13435.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14100.8,"10th_percentile":14100.8,"90th_percentile":14100.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4451.64,"10th_percentile":4451.64,"90th_percentile":4451.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Mcc","code_information":[{"code":"814","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17320.16,"maximum":88830.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31485.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56225.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18532.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53414.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37013.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56098.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37055.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39539.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17839.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17839.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34093.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63581.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88830.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38684.67},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":47061.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50064.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18532.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36287.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18532.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17839.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46523.69},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18532.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39233.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17320.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18012.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19260.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22862.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18532.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34191.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18359.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17320.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42019.34},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51049.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18186.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47591.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42019.34},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17320.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18532.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders With Cc","code_information":[{"code":"815","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8901.15,"maximum":42353.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15012.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26808.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9524.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25467.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17647.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26747.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17667.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18852.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9168.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9168.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16255.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30315.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42353.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18444.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22438.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23870.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9524.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17301.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9524.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9168.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22182.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9524.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18706.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8901.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9257.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9898.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11749.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9524.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17571.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9435.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8901.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20034.61},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24340.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9346.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22691.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20034.61},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8901.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9524.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Reticuloendothelial And Immunity Disorders Without Cc/Mcc","code_information":[{"code":"816","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6010.83,"maximum":26398.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9356.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16708.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6431.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15873.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10999.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16670.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11011.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11750.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6191.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6191.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10131.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18894.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26398.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11496.08},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13985.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14877.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6431.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10783.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6431.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6191.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13825.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6431.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11659.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6010.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6251.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6684.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7934.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6431.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11865.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6371.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6010.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12487.06},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15170.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6311.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14142.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12487.06},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6010.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6431.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Mcc","code_information":[{"code":"817","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18492.18,"maximum":95300.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33779.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60320.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19786.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":57304.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39708.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60184.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39754.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42419.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19046.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19046.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36576.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68213.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95300.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41502.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":50489.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53711.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19786.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38930.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19786.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19046.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":49912.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19786.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42090.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18492.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19231.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20563.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24409.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19786.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36505.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19601.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18492.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45079.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54767.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19416.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":51057.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45079.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18492.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19786.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Mcc","code_information":[{"code":"432","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16120.9,"maximum":82209.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29139.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52035.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17249.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":49433.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34254.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51917.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34293.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36592.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16604.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16604.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31552.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58843.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82209.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35801.56},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":43554.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46333.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17249.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33583.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17249.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16604.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43056.34},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17249.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36309.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16120.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16765.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17926.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21279.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17249.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31824.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17088.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16120.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38887.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47244.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16926.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44044.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38887.7},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16120.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17249.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17797.88,"10th_percentile":17797.88,"90th_percentile":17798.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16975.31,"10th_percentile":16975.31,"90th_percentile":16975.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis With Cc","code_information":[{"code":"433","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9220.45,"maximum":44116.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15637.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27923.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9865.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26527.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18382.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27860.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18403.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19636.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9497.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9497.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16931.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31577.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44116.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19212.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23372.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24864.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9865.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18021.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9865.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9497.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23105.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9865.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19484.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9220.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9589.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10253.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12170.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9865.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18202.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9773.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9220.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20868.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25353.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9681.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23635.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20868.4},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9220.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9865.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cirrhosis And Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"434","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6619.91,"maximum":29760.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10548.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18837.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7083.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17895.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12400.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18794.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12414.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13246.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6818.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6818.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11422.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21301.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29760.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12960.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15766.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16772.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7083.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12157.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7083.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6818.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15586.65},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7083.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13144.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6619.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6884.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7361.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8738.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7083.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13068.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7017.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6619.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14077.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17102.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6950.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15944.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14077.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6619.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7083.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24179.0,"maximum":126693.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44906.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80191.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25871.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":76181.85},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":52789.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":80009.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52850.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":56393.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24904.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24904.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":48625.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90683.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":126693.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":55173.91},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":67121.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71404.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25871.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":51755.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25871.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24904.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":66354.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25871.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55956.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24179.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25146.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26887.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31916.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25871.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25629.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24179.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59929.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72808.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25387.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":67876.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":59929.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24179.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25871.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity Without Mcc","code_information":[{"code":"470","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15823.55,"maximum":80568.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28557.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50996.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16931.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48446.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33570.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50880.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33609.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35862.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16298.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16298.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30922.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57668.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80568.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35086.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42684.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45408.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16931.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32912.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16931.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16298.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42196.62},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16931.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35584.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15823.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16456.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17595.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20887.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16931.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31237.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15823.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38111.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46301.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16614.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43164.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38111.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15823.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16931.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31527.23,"10th_percentile":31527.23,"90th_percentile":31527.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Mcc","code_information":[{"code":"471","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37764.27,"maximum":201689.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":71488.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127661.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40407.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":121277.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":84038.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":127371.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":84135.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":89775.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38897.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38897.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":77408.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":144363.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":201689.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":87834.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":106854.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113672.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40407.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":82392.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40407.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38897.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":105632.64},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40407.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89079.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37764.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39274.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41993.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":49848.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40407.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":74550.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40030.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37764.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":95405.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115908.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39652.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":108056.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":95405.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37764.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40407.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion With Cc","code_information":[{"code":"472","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23519.98,"maximum":123055.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43617.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77888.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25166.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":73994.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":51273.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77712.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51332.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54773.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":47228.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":88079.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":123055.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53589.56},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":65194.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69354.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25166.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":50269.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25166.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24225.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":64448.88},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25166.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54349.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23519.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24460.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26154.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31046.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25166.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46430.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24931.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23519.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58209.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70718.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24695.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65927.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":58209.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23519.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25166.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cervical Spinal Fusion Without Cc/Mcc","code_information":[{"code":"473","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19700.51,"maximum":101970.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36143.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64543.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21079.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61315.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42488.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64396.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42537.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45388.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20291.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39136.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":72987.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":101970.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44407.25},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":54023.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57470.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21079.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41655.9},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21079.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":53405.88},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21079.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45037.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19700.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20488.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21906.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26004.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21079.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38890.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20882.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19700.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48235.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58600.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20685.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":54631.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48235.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19700.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21079.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Mcc","code_information":[{"code":"474","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33710.26,"maximum":179310.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63556.38},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113495.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36069.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":107820.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":74713.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":113238.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":74799.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":79813.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34721.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34721.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":68819.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":128344.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":179310.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":78087.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":94997.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101059.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36069.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":73249.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36069.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34721.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":93911.48},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36069.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79195.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33710.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35058.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37485.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44497.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36069.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":66547.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35732.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33710.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":84819.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103046.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35395.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":96066.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":84819.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33710.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36069.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With Cc","code_information":[{"code":"475","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18447.54,"maximum":95053.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33691.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60164.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":57156.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39606.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60028.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39651.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42309.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19000.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19000.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36481.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68036.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95053.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41394.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":50358.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53572.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38830.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19000.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":49783.21},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41982.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18447.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19185.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20513.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24350.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19738.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36417.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19554.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18447.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44963.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54625.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19369.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50925.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44963.28},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18447.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19738.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"476","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10158.67,"maximum":49295.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17472.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31202.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29641.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20540.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31131.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20563.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21942.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10463.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10463.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18919.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35284.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49295.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21467.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26116.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27783.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20137.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10463.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25818.06},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21772.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10158.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10565.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11296.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13409.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10869.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20054.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10768.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10158.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23318.39},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28329.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10666.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26410.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23318.39},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10158.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10869.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"477","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27367.43,"maximum":144295.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51145.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91332.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29283.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":86765.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":60123.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":91125.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":60192.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":64227.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28188.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28188.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":55380.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":103282.18},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":144295.19},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":62839.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":76446.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81324.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29283.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":58945.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29283.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28188.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":75572.83},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29283.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63730.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27367.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28462.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30432.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36125.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29283.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54026.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29009.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27367.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":68255.99},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82924.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28735.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":77307.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":68255.99},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27367.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29283.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"478","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19835.95,"maximum":102718.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36408.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65016.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21224.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61765.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42799.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64868.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42849.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45721.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20431.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20431.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39423.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73522.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":102718.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44732.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":54419.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57892.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21224.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41961.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21224.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20431.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":53797.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21224.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45367.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19835.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20629.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22057.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26183.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21224.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39158.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21026.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19835.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48588.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59030.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20827.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55031.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48588.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19835.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21224.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Biopsies Of Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"479","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15293.91,"maximum":77644.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27521.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49145.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46688.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32352.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49034.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32389.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34560.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15752.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15752.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29800.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55575.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77644.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33813.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":41135.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43760.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31718.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15752.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40665.3},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34292.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15293.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15905.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17006.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20187.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30191.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16211.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15293.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36728.15},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44621.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16058.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41598.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36728.15},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15293.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16364.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Mcc","code_information":[{"code":"480","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23264.24,"maximum":121643.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43116.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76995.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24892.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":73145.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50685.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76820.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50743.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54145.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23962.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23962.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46687.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":87069.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":121643.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52974.74},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":64446.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68558.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24892.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49692.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24892.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23962.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":63709.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24892.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53726.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23264.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24194.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25869.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30708.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24892.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45925.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24660.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23264.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57541.22},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69906.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24427.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65171.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57541.22},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23264.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24892.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22357.72,"10th_percentile":22357.72,"90th_percentile":22357.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17076.52,"maximum":87485.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31009.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55374.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52605.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36452.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55248.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36494.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38940.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17588.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17588.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33576.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62619.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87485.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38098.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46349.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49306.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35738.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17588.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45819.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38639.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17076.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17759.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18989.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22541.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18271.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33710.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18101.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17076.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41383.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50276.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17930.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46870.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41383.13},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17076.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18271.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":17979.84,"10th_percentile":17979.84,"90th_percentile":17979.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13776.0,"10th_percentile":13776.0,"90th_percentile":13776.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18853.16,"10th_percentile":18247.64,"90th_percentile":18860.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":8541.06,"10th_percentile":8541.06,"90th_percentile":8541.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16073.78,"10th_percentile":16073.78,"90th_percentile":16073.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13569.55,"maximum":68125.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24146.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43120.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14519.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40964.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28385.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43022.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28418.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30323.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13976.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13976.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26146.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48762.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68125.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29667.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36092.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38395.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14519.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27829.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14519.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13976.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35679.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14519.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30088.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13569.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14112.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15089.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17911.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14519.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26787.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14383.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13569.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32225.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39150.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14248.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36498.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32225.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13569.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14519.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper Extremities","code_information":[{"code":"483","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22201.93,"maximum":115779.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41037.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73283.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23756.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":69619.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":48242.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":73117.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48297.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":51535.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22867.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22867.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":44436.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82871.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":115779.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50420.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":61339.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65253.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23756.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47296.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23756.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22867.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":60638.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23756.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51136.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22201.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23090.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24688.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29306.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23756.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43828.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23534.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22201.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54767.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66536.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23312.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":62029.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":54767.2},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22201.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23756.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21079.95,"10th_percentile":21079.95,"90th_percentile":21079.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Mcc","code_information":[{"code":"485","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25646.1,"maximum":134792.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47777.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85318.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27441.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":81051.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":56164.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":85124.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":56228.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59998.24},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26415.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26415.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51733.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":96480.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134792.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58700.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":71412.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75969.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27441.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55064.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27441.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26415.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":70596.04},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27441.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59533.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25646.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26671.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28518.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33852.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27441.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50627.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27184.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25646.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63761.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77463.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26928.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72216.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63761.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25646.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27441.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With Cc","code_information":[{"code":"486","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17050.8,"maximum":87343.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30958.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55284.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18244.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52520.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36393.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55159.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36435.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38877.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17562.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17562.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33522.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62517.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87343.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38037.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46273.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49226.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18244.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35680.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18244.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17562.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45744.9},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18244.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38576.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17732.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18960.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22507.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18244.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33659.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18073.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41315.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50194.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17903.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46794.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41315.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17050.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18244.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"487","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13079.25,"maximum":65418.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23187.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41407.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13994.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39336.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27258.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41313.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27289.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29118.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13471.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13471.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25107.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46824.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65418.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28489.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34658.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36869.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13994.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26724.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13994.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13471.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34262.19},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13994.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28893.26},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13079.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13602.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14544.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17264.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13994.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25819.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13864.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13079.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30944.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37595.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13733.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35048.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30944.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13079.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13994.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With Cc/Mcc","code_information":[{"code":"488","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14612.94,"maximum":73885.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26188.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46766.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15635.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44427.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30785.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46660.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30821.31},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32887.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15051.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15051.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28357.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52884.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73885.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32176.29},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39143.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41641.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15635.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30182.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15635.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15051.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38696.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15635.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32632.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14612.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15197.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16249.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19289.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15635.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28847.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15489.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14612.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34949.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42460.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15343.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39584.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34949.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14612.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15635.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9678.96,"maximum":46647.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16534.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29525.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28049.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19436.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29458.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19459.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20763.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9969.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9969.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17903.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33388.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46647.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20314.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24713.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26290.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19055.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9969.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24431.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20602.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9678.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10066.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10763.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12776.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19107.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10259.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9678.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22065.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26807.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10162.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24991.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22065.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9678.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Mcc","code_information":[{"code":"492","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29009.32,"maximum":153359.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54358.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97069.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31039.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92215.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":63900.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":96849.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":63973.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":68262.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29879.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29879.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":58859.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":109769.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":153359.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66786.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":81248.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86433.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31039.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":62648.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31039.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29879.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":80319.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31039.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67733.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29009.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30169.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32258.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38292.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31039.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57267.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30749.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29009.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":72543.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88133.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30459.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":82163.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":72543.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29009.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31039.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1050.0,"10th_percentile":1050.0,"90th_percentile":1050.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur With Cc","code_information":[{"code":"493","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20417.8,"maximum":105930.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37546.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67049.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21847.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":63696.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44138.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66897.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44189.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47151.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21030.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21030.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40656.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75821.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":105930.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46131.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":56121.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59702.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21847.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43273.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21847.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21030.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":55479.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21847.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46785.97},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21234.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22704.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26951.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21847.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40306.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21642.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50108.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60876.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21438.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56752.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":50108.26},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20417.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21847.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1400.0,"10th_percentile":1400.0,"90th_percentile":1400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5605.11,"10th_percentile":5605.11,"90th_percentile":5605.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7467.58,"10th_percentile":7467.58,"90th_percentile":7467.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lower Extremity And Humerus Procedures Except Hip, Foot And Femur Without Cc/Mcc","code_information":[{"code":"494","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16410.69,"maximum":83809.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29706.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53047.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17559.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50395.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34921.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52927.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34961.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37304.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16903.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16903.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32166.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59988.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83809.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36498.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44401.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47235.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17559.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34236.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17559.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16903.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43894.19},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17559.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37015.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16410.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17067.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18248.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21662.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17559.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32396.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17395.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16410.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39644.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48164.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17231.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44901.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39644.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16410.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17559.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13278.21,"10th_percentile":13278.21,"90th_percentile":13278.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Mcc","code_information":[{"code":"495","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28662.03,"maximum":151441.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53678.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95856.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30668.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":91063.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":63101.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":95638.71},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":63174.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":67409.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29521.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29521.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":58123.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":108397.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":151441.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65951.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":80233.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85352.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30668.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":61865.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30668.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29521.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":79315.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30668.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66886.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28662.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29808.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31872.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37833.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30668.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56581.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30381.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28662.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71636.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87031.3},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30095.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":81135.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":71636.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28662.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30668.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur With Cc","code_information":[{"code":"496","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14877.76,"maximum":75347.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26706.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47691.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15919.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45306.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31395.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47583.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31431.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33538.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28918.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53931.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75347.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32812.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39918.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42465.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15919.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30779.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15919.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15324.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39462.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15919.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33278.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15472.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16544.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19638.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15919.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29370.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15770.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35641.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43300.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15621.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40367.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35641.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14877.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15919.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Except Hip And Femur Without Cc/Mcc","code_information":[{"code":"497","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10371.28,"maximum":50469.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17888.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31945.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11097.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30347.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21029.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31872.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21053.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22464.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10682.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10682.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19370.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36124.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50469.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21978.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26738.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28444.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11097.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20617.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11097.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10682.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26432.77},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11097.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22290.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10371.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10786.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11532.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13690.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11097.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20473.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10993.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10371.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23873.59},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29004.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10889.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27039.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23873.59},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10371.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11097.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24054.91,"maximum":126008.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44663.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79758.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25738.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":75769.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":52504.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79577.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52564.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":56088.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24776.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24776.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":48362.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90193.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":126008.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":54875.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":66758.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71018.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25738.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":51475.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25738.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24776.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":65995.52},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25738.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55653.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24054.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25017.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26749.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31752.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25738.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47486.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25498.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24054.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59605.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72415.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25257.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":67509.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":59605.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24054.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25738.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Local Excision And Removal Of Internal Fixation Devices Of Hip And Femur Without Cc/Mcc","code_information":[{"code":"499","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16473.49,"maximum":84156.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29829.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53267.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17626.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50603.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35065.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53146.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35105.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37459.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16967.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16967.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32299.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60236.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84156.18},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36649.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44585.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47430.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17626.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34378.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17626.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16967.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":44075.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17626.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37169.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16473.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17132.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18318.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21745.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17626.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32520.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17461.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16473.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39808.42},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48363.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17297.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45087.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39808.42},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16473.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17626.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Mcc","code_information":[{"code":"500","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25174.72,"maximum":132190.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46854.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83670.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26936.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":79487.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":55080.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83481.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55143.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58839.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25929.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25929.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50734.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":94618.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":132190.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57567.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":70033.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74502.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26936.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":54000.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26936.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25929.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":69233.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26936.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58384.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25174.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26181.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27994.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33230.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26936.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49697.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26685.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25174.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62530.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75967.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26433.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70821.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62530.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25174.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26936.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With Cc","code_information":[{"code":"501","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14455.56,"maximum":73016.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25880.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46216.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15467.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43905.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30423.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46111.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30458.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32500.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14889.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14889.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28023.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52262.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73016.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31797.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38683.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41152.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15467.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29827.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15467.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14889.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38241.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15467.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32248.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14455.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15033.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16074.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19081.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15467.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28536.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15322.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14455.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34538.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41961.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15178.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39118.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34538.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14455.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15467.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures Without Cc/Mcc","code_information":[{"code":"502","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11412.4,"maximum":56216.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19926.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35582.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12211.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33803.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23424.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35502.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23450.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25022.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11754.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11754.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21576.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40238.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56216.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24481.92},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29783.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31683.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12211.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22965.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12211.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11754.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29442.91},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12211.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24829.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11412.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11868.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12690.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15064.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12211.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22529.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12097.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11412.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26592.29},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32306.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11983.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30118.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26592.29},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11412.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12211.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Mcc","code_information":[{"code":"503","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22347.2,"maximum":116581.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":41322.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73791.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23911.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":70101.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":48576.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":73623.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48632.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":51892.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23017.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23017.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":44744.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":83445.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":116581.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50770.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":61764.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65705.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23911.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47624.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23911.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23017.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":61058.1},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23911.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51490.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22347.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23241.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24850.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29498.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23911.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44115.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23688.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22347.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":55146.55},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66997.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23464.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":62459.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":55146.55},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22347.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23911.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures With Cc","code_information":[{"code":"504","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15371.84,"maximum":78074.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27673.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49417.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16447.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46946.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32531.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49305.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32568.94},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34752.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15833.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15833.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29965.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55883.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78074.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34000.75},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":41363.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44002.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16447.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31894.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16447.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15833.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40890.62},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16447.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34483.0},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15371.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15986.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17093.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20290.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16447.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30345.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16294.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15371.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36931.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44868.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16140.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41828.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36931.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15371.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16447.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14558.39,"10th_percentile":14558.39,"90th_percentile":14558.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14793.77,"maximum":74883.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26542.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47398.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15829.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45027.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31201.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47290.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31237.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33331.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15237.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15237.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28740.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53599.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74883.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32611.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39672.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42204.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15829.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30590.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15829.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15237.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39219.29},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15829.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33073.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14793.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15385.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16450.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19527.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15829.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29204.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15681.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14793.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35422.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43034.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15533.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40119.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35422.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14793.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15829.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16337.61,"10th_percentile":16337.61,"90th_percentile":16337.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint Procedures","code_information":[{"code":"506","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11437.37,"maximum":56354.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19974.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35670.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12237.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33886.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23481.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35589.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23508.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25084.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11780.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11780.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21629.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40337.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56354.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24541.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29856.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31761.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12237.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23021.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12237.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11780.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29515.1},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12237.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24890.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11437.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11894.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12718.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15097.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12237.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22578.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12123.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11437.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26657.49},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32386.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12009.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30192.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26657.49},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11437.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12237.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14896.68,"maximum":75451.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26743.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47757.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15939.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45369.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31438.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47649.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31474.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33584.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15343.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15343.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28958.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54005.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75451.52},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32858.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39973.83},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42524.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15939.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30822.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15939.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15343.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39516.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15939.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33324.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14896.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15492.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16565.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19663.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15939.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29407.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15790.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14896.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35690.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43360.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15641.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40423.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35690.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14896.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15939.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without Cc/Mcc","code_information":[{"code":"508","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12687.32,"maximum":63254.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22420.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40037.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13575.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38035.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26356.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39946.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26386.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28155.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13067.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13067.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24277.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45276.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63254.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27546.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33512.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35650.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13575.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25840.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13575.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13067.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33129.01},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13575.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27937.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12687.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13194.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14108.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16747.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13575.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25046.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13448.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12687.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29921.52},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36351.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13321.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33889.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29921.52},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12687.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13575.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Mcc","code_information":[{"code":"510","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24082.91,"maximum":126163.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44718.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79855.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25768.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":75862.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":52568.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79674.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52629.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":56157.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24805.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24805.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":48421.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":90303.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":126163.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":54942.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":66840.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71105.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25768.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":51538.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25768.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24805.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":66076.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25768.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55722.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26780.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31789.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25768.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47542.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25527.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59679.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72504.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25287.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":67592.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":59679.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24082.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25768.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With Cc","code_information":[{"code":"511","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16962.27,"maximum":86854.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30785.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54975.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18149.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52226.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36189.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54850.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36231.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38660.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17471.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17471.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33334.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62167.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86854.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37824.29},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46015.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48951.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18149.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35480.8},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18149.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17471.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45488.95},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18149.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38360.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16962.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17640.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18862.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22390.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18149.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33485.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17980.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16962.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41084.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49913.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17810.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46532.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41084.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16962.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18149.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":2898.24,"10th_percentile":2898.24,"90th_percentile":2898.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13754.17,"maximum":69144.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24508.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43765.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14716.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41577.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28810.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43666.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28843.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30777.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14166.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14166.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26537.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49491.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69144.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30111.73},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36632.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38969.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14716.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28246.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14716.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14166.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36213.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14716.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30538.82},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13754.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14304.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15294.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18155.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14716.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27152.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14579.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13754.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32707.39},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39736.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14441.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37044.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32707.39},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13754.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14716.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures With Cc/Mcc","code_information":[{"code":"513","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13140.54,"maximum":65756.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23307.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41621.34},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39540.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27399.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41526.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27430.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29269.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13534.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13534.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25237.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47066.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65756.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28636.52},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34837.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37060.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26862.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13534.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34439.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29042.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13140.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13666.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14612.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17345.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14060.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25940.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13928.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13140.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31105.02},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37789.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13797.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35229.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31105.02},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13140.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14060.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Or Wrist Procedures, Except Major Thumb Or Joint Procedures Without Cc/Mcc","code_information":[{"code":"514","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8963.95,"maximum":42700.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15135.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27027.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9591.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25676.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17792.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26966.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17812.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19006.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16388.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30563.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42700.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18595.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22622.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24065.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9591.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17443.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9591.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9232.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22363.83},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9591.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18859.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8963.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9322.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9967.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11832.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9591.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17695.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9501.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8963.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20198.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24539.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9412.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22877.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20198.6},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8963.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9591.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Mcc","code_information":[{"code":"515","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25341.94,"maximum":133113.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47182.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84255.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27115.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":80042.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":55464.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":84064.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55528.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59250.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26102.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26102.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51089.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":95278.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":133113.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57969.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":70522.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75022.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27115.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":54378.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27115.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26102.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":69716.62},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27115.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58791.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25341.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26355.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28180.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33451.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27115.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50027.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26862.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25341.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62966.77},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76498.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26609.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71316.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62966.77},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25341.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27115.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures With Cc","code_information":[{"code":"516","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16952.44,"maximum":86800.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30766.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54940.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52193.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36167.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54816.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36208.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38636.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17461.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17461.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33314.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62128.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86800.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37800.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":45986.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48920.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35458.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17461.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45460.52},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38336.79},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16952.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17630.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18851.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22377.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18139.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33465.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17969.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16952.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41059.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49882.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17800.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46503.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41059.1},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16952.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18139.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12856.05,"maximum":64186.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22750.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40627.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13755.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38595.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26744.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40535.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26775.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28570.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13241.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13241.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24634.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45942.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64186.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27952.57},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34005.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36175.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13755.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26220.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13755.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13241.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33616.85},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13755.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28349.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12856.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13370.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14295.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16969.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13755.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13627.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12856.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30362.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36886.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13498.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34388.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30362.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12856.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13755.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14201.31,"10th_percentile":14201.31,"90th_percentile":14201.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29506.42,"maximum":156103.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55330.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98806.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31571.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":93866.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":65043.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":98582.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":65118.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":69483.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30391.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30391.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":59912.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":111734.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":156103.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":67981.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":82702.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87979.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31571.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":63769.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31571.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30391.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":81757.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31571.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68945.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29506.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30686.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32811.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38948.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31571.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58248.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31276.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29506.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":73841.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89710.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30981.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":83633.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":73841.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29506.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31571.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16363.02,"maximum":83546.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29612.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52881.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17508.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50237.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34811.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52761.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34851.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37187.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16853.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16853.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32065.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59799.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83546.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36383.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44262.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47086.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17508.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34129.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17508.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16853.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43756.38},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17508.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36899.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16363.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17017.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18195.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21599.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17508.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32302.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17344.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16363.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39519.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48012.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17181.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44760.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39519.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16363.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17508.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without Cc/Mcc","code_information":[{"code":"520","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12532.21,"maximum":62398.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22117.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39495.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13409.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37520.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25999.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39406.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26029.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27774.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12908.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12908.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23948.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44663.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62398.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27174.04},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33058.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35167.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13409.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25490.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13409.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12908.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32680.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13409.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27559.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12532.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13033.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13935.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16542.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13409.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24739.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13284.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12532.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29516.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35859.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13158.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33430.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29516.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12532.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13409.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22945.69,"maximum":119885.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42493.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75882.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24551.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72087.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49952.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":75710.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50010.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53362.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23634.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23634.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46012.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":85810.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119885.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52208.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":63514.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67567.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24551.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":48974.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24551.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23634.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":62788.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24551.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52949.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23863.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25515.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30288.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24551.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45297.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24322.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56709.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68896.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24092.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64229.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":56709.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22945.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24551.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22343.37,"10th_percentile":22343.37,"90th_percentile":22343.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without Mcc","code_information":[{"code":"522","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17252.06,"maximum":88454.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31352.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55987.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18459.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53188.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36856.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55860.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36898.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39372.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17769.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17769.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33948.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63312.88},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88454.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38520.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46862.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49852.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18459.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36134.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18459.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17769.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46326.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18459.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39067.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17252.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17942.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19184.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22772.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18459.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34057.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18287.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17252.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41841.52},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50833.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18114.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47389.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41841.52},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17252.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18459.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22619.76,"10th_percentile":19057.01,"90th_percentile":22627.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17803.37,"10th_percentile":17803.37,"90th_percentile":17803.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur With Mcc","code_information":[{"code":"533","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13090.6,"maximum":65481.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23209.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41446.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14006.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39374.35},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27284.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41352.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27315.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29146.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13483.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13483.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25131.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46869.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65481.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28516.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34691.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36905.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14006.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26749.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14006.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13483.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34295.01},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14006.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28920.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13090.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13614.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14556.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17279.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14006.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25842.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13876.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13090.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30974.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37631.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13745.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35081.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30974.62},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13090.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14006.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without Mcc","code_information":[{"code":"534","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7328.12,"maximum":33669.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11934.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21311.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20246.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14029.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21263.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14045.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14987.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7547.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7547.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12922.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24099.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33669.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14662.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17838.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18976.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13754.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7547.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17634.24},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14870.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7328.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7621.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8148.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9673.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7841.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14466.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7767.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7328.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15926.92},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19349.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7694.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18038.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15926.92},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7328.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7841.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis With Mcc","code_information":[{"code":"535","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10928.91,"maximum":53547.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18980.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33893.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11693.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32198.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22311.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33816.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22337.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23834.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11256.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11256.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20551.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38327.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53547.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23319.58},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28369.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30179.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11693.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21874.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11693.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11256.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28045.03},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11693.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23650.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10928.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11366.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12152.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14426.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11693.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21574.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11584.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10928.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25329.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30773.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11475.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28688.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25329.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10928.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11693.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12070.7,"10th_percentile":12070.7,"90th_percentile":12070.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Hip And Pelvis Without Mcc","code_information":[{"code":"536","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7339.47,"maximum":33732.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11956.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21351.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7853.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20283.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14055.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21302.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14071.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15014.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7559.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7559.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12946.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24144.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33732.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14690.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17871.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19011.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7853.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13780.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7853.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7559.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17667.06},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7853.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14898.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7339.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7633.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8161.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9688.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7853.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14488.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7779.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7339.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15956.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19385.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7706.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18072.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15956.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7339.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7853.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8449.44,"maximum":39860.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14128.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25229.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9040.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23968.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16608.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25172.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16627.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17742.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8702.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8702.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15298.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28530.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39860.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17358.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21117.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22465.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9040.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16283.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9040.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8702.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20876.27},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9040.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17604.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8787.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9395.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11153.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9040.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16680.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8956.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18855.06},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22907.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8871.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21355.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18855.06},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8449.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9040.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6678.93,"maximum":30086.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10664.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19043.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7146.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18091.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12536.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19000.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12550.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13391.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6879.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6879.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11547.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21534.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30086.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13102.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15939.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16956.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7146.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12290.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7146.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6879.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15757.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7146.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13288.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6946.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7426.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8816.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7146.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13184.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7079.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14231.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17290.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7012.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16118.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14231.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6678.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7146.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Mcc","code_information":[{"code":"539","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16132.25,"maximum":82272.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29161.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52074.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":49470.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34280.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51956.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34320.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36620.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16616.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16616.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31576.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58888.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82272.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35828.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":43587.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46368.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33608.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16616.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43089.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36337.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16132.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16777.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17939.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21294.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17261.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31846.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17100.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16132.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38917.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47280.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16938.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44077.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38917.33},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16132.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17261.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31937.66,"10th_percentile":31937.66,"90th_percentile":31937.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With Cc","code_information":[{"code":"540","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11037.11,"maximum":54145.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19191.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34271.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32557.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22560.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34193.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22586.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24100.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11368.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11368.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20780.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38755.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54145.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23579.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28685.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30516.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22118.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11368.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28357.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23914.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11037.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11478.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12273.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14568.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21788.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11699.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11037.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25612.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31116.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11588.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29008.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25612.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11037.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without Cc/Mcc","code_information":[{"code":"541","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7186.63,"maximum":32888.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11657.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20817.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19776.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13703.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20770.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13719.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14639.34},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12622.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23540.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32888.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14322.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17424.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18536.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13435.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7402.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17225.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14525.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7186.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7474.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7991.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9486.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7689.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14187.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7617.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7186.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15557.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18900.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7545.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17620.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15557.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7186.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7689.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Mcc","code_information":[{"code":"542","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14594.78,"maximum":73784.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26153.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46702.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15616.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44367.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30744.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46596.74},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30779.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32842.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15032.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15032.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28318.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52813.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73784.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32132.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39090.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41585.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15616.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30141.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15616.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15032.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38643.95},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15616.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32588.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14594.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15178.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16229.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19265.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15616.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28811.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15470.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14594.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34902.51},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42403.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15324.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39530.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34902.51},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14594.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15616.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With Cc","code_information":[{"code":"543","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9007.08,"maximum":42938.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15219.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27178.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9637.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25819.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17891.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27116.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17911.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19112.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16479.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30734.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42938.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18699.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22748.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24200.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9637.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17540.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9637.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9277.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22488.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9637.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18964.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9007.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9367.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10015.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11889.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9637.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17780.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9547.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9007.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20311.22},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24676.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9457.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23004.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20311.22},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9007.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9637.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":9475.04,"10th_percentile":9475.04,"90th_percentile":9475.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11818.68,"10th_percentile":11818.68,"90th_percentile":11818.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without Cc/Mcc","code_information":[{"code":"544","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6938.45,"maximum":31518.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11171.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19950.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18952.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13133.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19904.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13148.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14029.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7146.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7146.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12096.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22560.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31518.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13726.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16698.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17764.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12875.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7146.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16507.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13920.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6938.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7215.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7715.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9158.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7424.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13697.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7354.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6938.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14909.39},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18113.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7285.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16886.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14909.39},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6938.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7424.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Mcc","code_information":[{"code":"545","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20006.19,"maximum":103658.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36741.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65611.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21406.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":62330.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43191.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":65462.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":43241.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46139.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20606.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20606.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39784.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":74195.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":103658.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45142.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":54917.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58421.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21406.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":42345.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21406.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20606.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":54289.67},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21406.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45782.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20006.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20806.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22246.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26408.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21406.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39494.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21206.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20006.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49033.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59570.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21006.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55535.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":49033.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20006.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21406.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With Cc","code_information":[{"code":"546","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9955.89,"maximum":48176.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17076.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30493.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10652.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28968.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20073.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30424.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20096.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21444.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10254.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10254.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18490.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34483.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48176.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20980.35},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25523.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27152.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10652.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19680.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10652.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10254.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25231.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10652.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21277.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9955.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10354.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11070.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13141.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10652.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19653.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10553.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9955.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22788.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27686.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10453.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25810.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22788.88},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9955.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10652.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without Cc/Mcc","code_information":[{"code":"547","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7555.86,"maximum":34927.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12379.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22107.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21002.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14553.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22057.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14569.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15546.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7782.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7782.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13405.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24999.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34927.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15210.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18504.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19684.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14268.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7782.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18292.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15426.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7555.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7858.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8402.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9973.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8084.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14916.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8009.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7555.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16521.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20072.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7933.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18712.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16521.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7555.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8084.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Mcc","code_information":[{"code":"548","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15838.68,"maximum":80651.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28586.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51049.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16947.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48496.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33605.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50933.28},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33644.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35899.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30954.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57728.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80651.76},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35123.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42728.89},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45455.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16947.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32946.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16947.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16313.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42240.37},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16947.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35621.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15838.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16472.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17612.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20907.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16947.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31267.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16789.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15838.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38150.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46349.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16630.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43209.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38150.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15838.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16947.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With Cc","code_information":[{"code":"549","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10362.95,"maximum":50423.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17872.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31915.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11088.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30320.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21010.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31843.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21034.25},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22444.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10673.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10673.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19352.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36091.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50423.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21958.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26714.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28418.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11088.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20598.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11088.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10673.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26408.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11088.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22270.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10362.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10777.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11523.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13679.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11088.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10984.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10362.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23851.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28977.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10881.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27014.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23851.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10362.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11088.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without Cc/Mcc","code_information":[{"code":"550","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7842.62,"maximum":36510.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12941.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23109.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8391.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21953.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15212.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23057.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15230.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16251.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8077.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8077.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14012.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26132.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36510.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15899.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19342.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20577.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8391.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14914.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8391.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8077.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19121.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8391.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16125.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7842.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8156.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8720.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10352.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8391.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15482.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8313.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7842.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17270.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20981.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8234.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19560.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17270.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7842.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8391.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With Mcc","code_information":[{"code":"551","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13910.79,"maximum":70009.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24814.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44312.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14884.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42096.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29170.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44212.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29204.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31162.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14328.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14328.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26869.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50110.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70009.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30488.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37090.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39457.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14884.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28599.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14884.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14328.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36666.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14884.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30920.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13910.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14467.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15468.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18362.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14884.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27461.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14745.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13910.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33116.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40233.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14606.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37507.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33116.38},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13910.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14884.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13055.54,"10th_percentile":13055.54,"90th_percentile":13055.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18230.87,"10th_percentile":13801.4,"90th_percentile":18239.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5249.17,"10th_percentile":5249.17,"90th_percentile":5249.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without Mcc","code_information":[{"code":"552","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8502.4,"maximum":40152.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14232.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25414.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9097.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24144.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16730.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25357.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16749.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17872.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8757.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8757.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15410.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28739.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40152.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17486.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21272.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22629.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9097.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16402.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9097.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8757.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21029.4},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9097.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17734.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8842.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9454.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11223.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9097.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16784.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9012.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18993.37},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23075.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8927.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21511.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18993.37},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8502.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9097.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5172.24,"10th_percentile":5172.24,"90th_percentile":5172.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9384.88,"10th_percentile":6894.32,"90th_percentile":11156.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":8198.42,"10th_percentile":8198.42,"90th_percentile":8198.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":9121.63,"10th_percentile":9121.63,"90th_percentile":9121.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Bone Diseases And Arthropathies With Mcc","code_information":[{"code":"553","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11037.11,"maximum":54145.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19191.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34271.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32557.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22560.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34193.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22586.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24100.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11368.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11368.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20780.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38755.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54145.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23579.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28685.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30516.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22118.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11368.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28357.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23914.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11037.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11478.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12273.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14568.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21788.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11699.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11037.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25612.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31116.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11588.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29008.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25612.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11037.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11809.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7220.86,"10th_percentile":7220.86,"90th_percentile":7220.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":286.0,"10th_percentile":286.0,"90th_percentile":286.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone Diseases And Arthropathies Without Mcc","code_information":[{"code":"554","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7509.71,"maximum":34672.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12289.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21946.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8035.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20848.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14447.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21896.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14463.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15433.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7735.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7735.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13307.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24817.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34672.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15099.52},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18369.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19541.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8035.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14164.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8035.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7735.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18159.27},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8035.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15313.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7509.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7810.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8350.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9912.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8035.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14824.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7960.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7509.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16401.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19925.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7885.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18575.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16401.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7509.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8035.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11230.05,"maximum":55210.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19569.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34945.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12016.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33198.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23004.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34866.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23031.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24574.91},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11566.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11566.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21189.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39517.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55210.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24043.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29250.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31116.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12016.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22553.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12016.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11566.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28915.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12016.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24384.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11230.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11679.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12487.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14823.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12016.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22169.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11903.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11230.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26116.12},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31728.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11791.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29579.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26116.12},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11230.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12016.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without Mcc","code_information":[{"code":"556","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7513.49,"maximum":34693.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12297.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21959.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20861.35},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14455.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21909.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14472.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15442.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7738.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7738.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13315.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24832.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34693.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15108.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18380.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19553.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14172.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7738.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18170.21},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15322.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7513.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7814.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8355.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9917.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14832.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7964.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7513.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16410.99},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19937.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7889.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18587.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16410.99},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7513.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8039.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8298.1,"10th_percentile":8298.1,"90th_percentile":8298.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12479.25,"maximum":62106.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22013.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39310.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13352.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37344.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25878.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39221.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25907.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27644.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12853.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12853.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23836.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44453.85},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62106.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27046.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32903.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35003.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13352.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25370.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13352.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12853.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32527.42},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13352.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27430.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12479.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12978.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13876.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16472.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13352.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24635.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13228.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12479.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29378.17},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35691.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13103.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33273.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29378.17},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12479.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13352.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without Cc/Mcc","code_information":[{"code":"745","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9835.58,"maximum":47512.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16840.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30073.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10524.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28569.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19797.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30004.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19819.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21148.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10130.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10130.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18235.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34007.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47512.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20691.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25171.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26777.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10524.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19409.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10524.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10130.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24883.95},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10524.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20984.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9835.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10229.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10937.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12982.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10524.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19416.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10425.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9835.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22474.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27304.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10327.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25454.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22474.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9835.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10524.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With Cc/Mcc","code_information":[{"code":"746","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14372.33,"maximum":72556.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25717.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45925.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43629.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30232.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45821.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30267.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32296.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14803.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14803.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27847.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51934.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72556.93},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31597.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38440.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40893.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29640.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14803.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38000.8},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32046.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14372.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14947.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15982.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18971.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15378.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28372.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15234.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14372.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34321.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41697.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15090.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38872.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34321.62},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14372.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15378.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":42835.15,"10th_percentile":42835.15,"90th_percentile":42835.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without Cc/Mcc","code_information":[{"code":"747","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7733.67,"maximum":35908.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12727.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22728.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8275.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21592.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14962.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22677.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14979.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15983.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7965.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7965.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13781.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25702.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35908.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15637.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19024.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20238.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8275.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14669.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8275.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7965.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18806.8},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8275.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15859.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7733.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8043.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8599.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10208.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8275.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15267.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8197.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7733.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16985.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20636.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8120.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19238.37},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16985.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7733.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8275.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Female Reproductive System Reconstructive Procedures","code_information":[{"code":"748","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11725.64,"maximum":57946.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20538.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36677.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12546.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34843.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24144.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36594.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24172.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25792.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22239.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41476.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57946.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25234.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30699.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32658.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12546.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23671.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12546.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12077.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30348.57},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12546.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25592.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11725.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12194.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13038.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15477.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12546.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23147.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12429.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11725.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27410.27},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33300.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12311.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31045.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27410.27},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11725.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12546.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures With Cc/Mcc","code_information":[{"code":"749","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20656.14,"maximum":107246.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38013.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67882.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22102.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":64487.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44686.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":67728.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44737.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47736.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21275.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21275.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41161.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":76763.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107246.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46704.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":56818.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60443.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22102.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43810.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22102.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21275.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":56168.82},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22102.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47367.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20656.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21482.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22969.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27266.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22102.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40777.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21895.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20656.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50730.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61632.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21688.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":57457.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":50730.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20656.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22102.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12395.26,"maximum":61642.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21849.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39017.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13262.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37066.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25684.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38928.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25714.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27438.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23658.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44121.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61642.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26844.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32657.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34741.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13262.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25181.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13262.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12767.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32284.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13262.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27225.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12395.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12891.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13783.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16361.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13262.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24469.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13138.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12395.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29158.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35425.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13015.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33025.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29158.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12395.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13262.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15163.77,"maximum":76925.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27266.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48690.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16225.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46256.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32052.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48580.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32089.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34240.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15618.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15618.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29524.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55061.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76925.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33500.52},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40754.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43355.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16225.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31424.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16225.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15618.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40289.03},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16225.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33975.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15163.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15770.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16862.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20016.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16225.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29934.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16073.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15163.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36388.31},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44208.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15921.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41213.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36388.31},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15163.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16225.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Cc","code_information":[{"code":"755","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9459.54,"maximum":45436.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16104.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28759.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10121.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27321.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18932.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28693.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18953.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20224.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9743.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9743.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17438.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32521.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45436.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19787.08},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24071.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25607.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10121.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18561.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10121.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9743.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23796.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10121.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20067.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9459.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9837.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10519.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12486.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10121.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18674.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10027.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9459.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21492.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26111.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9932.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24342.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21492.75},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9459.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10121.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"756","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8496.35,"maximum":40119.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14220.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25393.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9091.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24123.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16716.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25336.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16735.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17857.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8751.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8751.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15397.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28716.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40119.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17471.5},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21254.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22611.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9091.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16389.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9091.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8751.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21011.9},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9091.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17719.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8496.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8836.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9447.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11215.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9091.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16772.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9006.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8496.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18977.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23055.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8921.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21494.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18977.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8496.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9091.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Mcc","code_information":[{"code":"757","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12063.1,"maximum":59809.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21199.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37856.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12907.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35963.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24920.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37770.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24949.43},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26621.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12424.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12424.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22954.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42809.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59809.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26046.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31686.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33708.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12907.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24432.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12907.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12424.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31324.24},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12907.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26415.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12063.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12545.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13414.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15923.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12907.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23813.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12786.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12063.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28291.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34371.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12666.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32043.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28291.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12063.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12907.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System With Cc","code_information":[{"code":"758","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8636.33,"maximum":40891.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14494.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25882.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9240.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24588.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17038.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25824.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17058.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18201.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8895.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8895.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15694.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29269.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40891.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17808.01},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21664.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23046.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9240.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16704.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9240.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8895.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21416.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9240.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18060.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8636.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8981.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9603.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11399.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9240.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17048.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9154.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8636.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19343.08},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23499.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9068.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21908.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19343.08},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8636.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9240.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without Cc/Mcc","code_information":[{"code":"759","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6249.92,"maximum":27717.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9824.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17544.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6687.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16666.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11549.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17504.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11562.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12337.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6437.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6437.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10638.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19839.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27717.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12070.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14684.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15621.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6687.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11323.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6687.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6437.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14516.91},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6687.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12242.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6249.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6499.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6949.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8249.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6687.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12337.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6624.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6249.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13111.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15929.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6562.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14850.04},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13111.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6249.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6687.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders With Cc/Mcc","code_information":[{"code":"760","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8851.97,"maximum":42082.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14916.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26636.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9471.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25304.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17534.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26575.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17554.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18731.44},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9117.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9117.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16151.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30121.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42082.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18326.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22294.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23717.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9471.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17190.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9471.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9117.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22040.07},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9471.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18586.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8851.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9206.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9843.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11684.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9471.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17474.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9383.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8851.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19906.19},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24184.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9294.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22545.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19906.19},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8851.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9471.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Menstrual And Other Female Reproductive System Disorders Without Cc/Mcc","code_information":[{"code":"761","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5545.5,"maximum":23829.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8446.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15082.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5933.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":14328.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9928.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":15048.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9940.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10606.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9145.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":17056.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23829.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10377.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":12624.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13430.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5933.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":9734.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5933.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5711.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":12480.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5933.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10524.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5545.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5767.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6166.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5933.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10947.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5878.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5545.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":11271.94},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13694.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5822.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12766.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":11271.94},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5545.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5933.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With O.R. Procedures Except Sterilization And/Or D&C","code_information":[{"code":"768","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9336.97,"maximum":44759.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15865.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28330.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9990.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26914.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18650.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28266.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18671.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19923.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9617.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9617.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17178.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32037.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44759.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19492.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23713.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25226.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9990.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18284.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9990.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9617.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23442.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9990.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19768.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9336.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9710.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10382.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12324.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9990.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18432.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9897.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9336.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21172.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25722.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9803.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23980.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21172.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9336.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9990.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14014.45,"maximum":70581.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25017.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44674.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14995.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42441.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29409.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44573.54},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29443.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31416.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14434.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14434.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27089.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50519.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70581.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30737.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37393.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39779.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14995.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28833.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14995.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14434.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36966.06},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14995.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31173.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14014.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14575.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15584.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18499.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14995.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14855.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14014.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33387.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40561.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14715.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37814.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33387.07},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14014.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14995.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":14033.12,"10th_percentile":14033.12,"90th_percentile":14033.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8815.65,"maximum":41881.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14844.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26509.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9432.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25183.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17450.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26449.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17471.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18642.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9080.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9080.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16074.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29977.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41881.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18239.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22188.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23604.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9432.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17109.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9432.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9080.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21935.07},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9432.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18497.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8815.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9168.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9803.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11636.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9432.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17402.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9344.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8815.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19811.35},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24068.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9256.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22438.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19811.35},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8815.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9432.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses Without O.R. Procedures","code_information":[{"code":"776","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6182.58,"maximum":27346.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9692.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17308.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6615.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16443.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11394.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17269.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11407.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12172.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6368.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6368.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10495.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19573.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27346.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11908.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14487.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15412.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6615.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11171.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6615.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6368.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14322.22},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6615.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12077.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6182.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6429.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6875.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8161.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6615.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12205.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6553.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6182.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12935.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15715.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6491.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14650.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12935.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6182.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6615.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":9692.83,"10th_percentile":9692.83,"90th_percentile":9692.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":15927.74,"10th_percentile":15927.74,"90th_percentile":15927.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7594.45,"maximum":35140.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12455.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22242.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8126.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21130.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14641.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22191.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14658.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15641.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7822.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7822.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13486.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25152.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35140.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15303.25},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18617.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19805.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8126.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14355.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8126.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7822.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18404.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8126.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15520.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7594.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7898.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8445.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10024.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8126.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14992.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8050.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7594.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16622.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20194.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7974.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18826.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16622.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7594.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8126.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Mcc","code_information":[{"code":"783","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19804.93,"maximum":102547.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36347.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64907.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21191.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61662.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42728.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64760.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42777.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45645.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20399.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20399.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39357.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73400.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":102547.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44658.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":54328.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57795.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21191.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41891.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21191.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20399.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":53707.77},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21191.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45291.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19804.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20597.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22023.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26142.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21191.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39096.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20993.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19804.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48507.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58932.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20795.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":54940.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48507.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19804.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21191.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization With Cc","code_information":[{"code":"784","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9249.95,"maximum":44279.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15694.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28026.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9897.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26625.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18449.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27963.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18471.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19709.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16994.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31693.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44279.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19283.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23458.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24955.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9897.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18088.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9897.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9527.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23190.75},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9897.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19556.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9249.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9619.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10285.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12209.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9897.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18260.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9804.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9249.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20945.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25446.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9712.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23722.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20945.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9249.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9897.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section With Sterilization Without Cc/Mcc","code_information":[{"code":"785","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8475.92,"maximum":40006.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14180.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25322.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9069.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24056.1},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16669.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25264.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16688.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17807.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8730.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8730.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15354.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28635.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40006.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17422.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21195.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22547.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9069.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16342.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9069.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8730.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20952.83},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9069.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17669.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8475.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8814.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9425.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11188.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9069.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16732.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8984.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8475.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18924.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22991.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8899.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21433.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18924.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8475.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9069.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Mcc","code_information":[{"code":"786","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13709.52,"maximum":68897.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24420.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43609.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14669.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41428.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28707.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43510.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28740.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30667.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14120.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14120.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26443.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49315.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68897.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30004.41},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36501.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38830.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14669.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28145.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14669.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14120.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36084.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14669.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30429.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13709.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14257.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15244.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18096.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14669.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27063.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14532.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13709.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32590.82},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39594.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14395.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36912.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32590.82},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13709.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14669.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization With Cc","code_information":[{"code":"787","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9678.96,"maximum":46647.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16534.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29525.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28049.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19436.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29458.95},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19459.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20763.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9969.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9969.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17903.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33388.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46647.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20314.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24713.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26290.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19055.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9969.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24431.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20602.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9678.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10066.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10763.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12776.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19107.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10259.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9678.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22065.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26807.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10162.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24991.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22065.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9678.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10356.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section Without Sterilization Without Cc/Mcc","code_information":[{"code":"788","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8483.49,"maximum":40048.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14195.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25348.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9077.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24081.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16686.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25291.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16706.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17826.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8737.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8737.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15370.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28665.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40048.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17440.57},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21217.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22571.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9077.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16360.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9077.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8737.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20974.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9077.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17687.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8483.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8822.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9433.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11198.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9077.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16747.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8992.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8483.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18943.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23015.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8907.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21456.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18943.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8483.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9077.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neonates, Died Or Transferred To Another Acute Care Facility","code_information":[{"code":"789","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14864.9,"maximum":75276.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26681.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47646.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15905.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45264.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31365.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47538.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31401.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33506.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15310.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15310.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28891.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53880.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75276.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32782.02},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39880.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42425.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15905.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30750.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15905.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15310.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39424.93},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15905.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33246.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14864.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15459.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16529.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19621.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15905.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29344.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15756.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14864.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35607.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43260.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15608.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40329.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35607.87},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14864.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15905.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, Neonate","code_information":[{"code":"790","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46199.17,"maximum":248254.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":87993.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157134.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49433.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":149276.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":103440.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":156777.64},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":103559.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":110501.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47585.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47585.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":95280.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":177692.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":248254.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":108112.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":131523.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139915.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49433.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":101413.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49433.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47585.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":130020.01},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49433.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109645.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46199.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48047.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51373.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":60982.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49433.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":91201.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48971.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46199.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":117431.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142667.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48509.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":133003.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":117431.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46199.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49433.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Mcc","code_information":[{"code":"435","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15125.93,"maximum":76717.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27192.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48558.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16184.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46130.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31965.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48448.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32002.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34147.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15579.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15579.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29444.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54911.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76717.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33409.57},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40644.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43237.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16184.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31339.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16184.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15579.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40179.65},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16184.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33883.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15125.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15730.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16820.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19966.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16184.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29860.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16033.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15125.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36289.52},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44088.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15882.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41101.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36289.52},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15125.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16184.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With Cc","code_information":[{"code":"436","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9787.16,"maximum":47244.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16745.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29904.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10472.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28408.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19685.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29836.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19708.29},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21029.41},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10080.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10080.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18132.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33816.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47244.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20574.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25030.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26627.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10472.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19299.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10472.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10080.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24743.94},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10472.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20866.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9787.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10178.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10883.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12919.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10472.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19320.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10374.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9787.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22348.27},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27150.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10276.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25311.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22348.27},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9787.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10472.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":33816.5,"10th_percentile":33816.5,"90th_percentile":33816.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without Cc/Mcc","code_information":[{"code":"437","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7685.25,"maximum":35641.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12633.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22559.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8223.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21431.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14850.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22508.35},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14867.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15864.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7915.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7915.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13679.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25511.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35641.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15521.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18882.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20087.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8223.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14559.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8223.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7915.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18666.79},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8223.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15741.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7685.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7992.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8546.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10144.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8223.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15171.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8146.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7685.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16859.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20482.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8069.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19095.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16859.5},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7685.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8223.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13563.5,"maximum":68091.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24135.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43099.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14512.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40944.1},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28372.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43001.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28404.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30308.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26133.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48738.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68091.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29653.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36074.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38376.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14512.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27816.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14512.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13970.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35662.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14512.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30073.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13563.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14106.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15082.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17903.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14512.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26775.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14377.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13563.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32209.49},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39131.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14241.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36480.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32209.49},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13563.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14512.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":28404.6,"10th_percentile":28404.6,"90th_percentile":28404.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7593.69,"maximum":35136.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12453.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22239.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8125.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21127.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14640.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22189.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14657.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15639.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7821.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7821.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13485.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25149.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35136.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15301.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18614.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19802.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8125.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14353.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8125.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7821.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18402.09},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8125.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15518.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7897.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8444.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10023.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8125.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14990.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8049.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16620.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20192.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7973.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18824.37},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16620.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7593.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8125.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6182.87,"10th_percentile":6182.87,"90th_percentile":6182.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5930.62,"maximum":25955.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9199.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16428.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6345.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15607.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10814.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16391.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10827.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11553.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6108.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6108.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9961.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18578.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25955.26},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11303.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13750.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14628.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6345.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10602.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6345.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6108.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13593.75},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6345.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11463.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5930.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6167.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6594.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7828.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6345.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11707.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6286.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5930.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12277.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14916.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6227.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13905.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12277.62},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5930.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6345.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4284.96,"10th_percentile":4284.96,"90th_percentile":4284.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Mcc","code_information":[{"code":"441","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14808.15,"maximum":74962.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26570.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47448.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15844.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45075.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31234.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47340.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31270.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33367.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15252.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15252.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28770.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53656.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":74962.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32645.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39714.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42249.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15844.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30622.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15844.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15252.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39260.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15844.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33108.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14808.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15400.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16466.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19546.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15844.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29232.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15696.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14808.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35459.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43079.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15548.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40161.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35459.68},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14808.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15844.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7358.83,"10th_percentile":7358.83,"90th_percentile":7358.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With Cc","code_information":[{"code":"442","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8532.67,"maximum":40319.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14291.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25520.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9129.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24244.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16800.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25462.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16819.39},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17946.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8788.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8788.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15474.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28859.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40319.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17558.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21361.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22724.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9129.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16470.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9129.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8788.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21116.9},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9129.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17807.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8873.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9488.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11263.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9129.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16844.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9044.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19072.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23171.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8959.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21601.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19072.4},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8532.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9129.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3235.53,"10th_percentile":3235.53,"90th_percentile":3235.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6523.06,"maximum":29225.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10359.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18498.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17573.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12177.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18456.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12191.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13008.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6718.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6718.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11216.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20918.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29225.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12727.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15483.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16471.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11938.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6718.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15306.64},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12908.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6523.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6783.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7253.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8610.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12877.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6914.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6523.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13824.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16795.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6849.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15657.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13824.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6523.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6979.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Mcc","code_information":[{"code":"444","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13871.44,"maximum":69791.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24737.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44175.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41966.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29080.34},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44075.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29113.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31065.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14287.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14287.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26786.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49954.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69791.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30393.67},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36975.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39334.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28510.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14287.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36552.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30824.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13871.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14426.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15425.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18310.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14842.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27383.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14703.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13871.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33013.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40108.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14565.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37391.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33013.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13871.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14842.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5207.05,"10th_percentile":5207.05,"90th_percentile":5207.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18188.28,"10th_percentile":18188.28,"90th_percentile":18188.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With Cc","code_information":[{"code":"445","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9509.48,"maximum":45711.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16202.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28933.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27486.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19046.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28868.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19068.83},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20347.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9794.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9794.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17544.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32719.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45711.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19907.14},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24217.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25763.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18673.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9794.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23941.09},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20189.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9509.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9889.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10574.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12552.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10175.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18772.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10080.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9509.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21623.16},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26269.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9984.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24490.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21623.16},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9509.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10175.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":27555.9,"10th_percentile":27555.9,"90th_percentile":27555.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9107.22,"10th_percentile":9107.22,"90th_percentile":9107.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10498.74,"10th_percentile":10498.74,"90th_percentile":10498.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without Cc/Mcc","code_information":[{"code":"446","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7488.52,"maximum":34555.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12248.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21872.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8012.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20778.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14398.33},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21822.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14414.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15381.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7713.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7713.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13262.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24733.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34555.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15048.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18307.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19475.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8012.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14116.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8012.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7713.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18098.01},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8012.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15262.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7488.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7788.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8327.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9884.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8012.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14783.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7937.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7488.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16345.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19858.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7862.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18513.32},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16345.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7488.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8012.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":51783.85,"maximum":279083.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":98921.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":176648.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55408.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":167815.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":116286.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":176247.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":116420.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":124224.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53337.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":53337.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":107112.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":199759.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":279083.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":121538.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":147857.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157291.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55408.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":114008.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55408.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53337.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":146166.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55408.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123262.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51783.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53855.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57583.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":68354.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55408.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102226.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54890.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51783.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":132015.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160385.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54373.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":149520.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":132015.05},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51783.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55408.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33316.05,"maximum":177133.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62785.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112118.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35648.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":106511.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":73806.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111863.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":73891.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":78844.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34315.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34315.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67984.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":126787.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":177133.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":77140.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":93844.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99832.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35648.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":72360.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35648.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34315.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":92771.74},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35648.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78234.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34648.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37047.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43977.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35648.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65769.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35315.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":83789.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101796.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34981.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":94900.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":83789.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33316.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35648.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody F","code_information":[{"code":"450","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41554.23,"maximum":222612.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78904.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140903.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44463.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":133858.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":92756.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":140584.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":92862.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":99087.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42800.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":42800.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":85438.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":159339.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":222612.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":96945.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":117938.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125464.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44463.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":90938.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44463.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42800.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":116590.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44463.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98320.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41554.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43216.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46208.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":54851.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44463.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":82032.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44047.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41554.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105302.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127931.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43631.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":119265.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":105302.24},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41554.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44463.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25671.07,"maximum":134930.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47826.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85405.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27468.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":81134.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":56221.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":85211.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":56286.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60059.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26441.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26441.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51786.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":96579.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134930.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58760.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":71485.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76046.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27468.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55120.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27468.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26441.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":70668.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27468.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59594.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25671.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26697.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28546.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33885.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27468.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50677.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27211.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25671.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63826.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77542.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26954.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72289.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63826.24},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25671.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27468.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":64811.49,"maximum":351001.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":124412.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":222169.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69348.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":211059.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":146252.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":221664.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":146420.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":156236.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66755.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":66755.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":134714.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":251236.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":351001.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":152857.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":185958.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":197824.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69348.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":143387.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69348.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66755.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":183832.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69348.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155025.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64811.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67403.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72070.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":85551.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69348.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":127944.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68700.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64811.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":166034.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201715.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68052.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":188051.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":166034.38},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64811.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69348.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"457","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46347.47,"maximum":249072.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":88283.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157652.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49591.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":149769.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":103781.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":157294.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":103901.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":110865.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47737.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47737.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":95594.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":178278.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":249072.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":108468.79},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":131957.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140377.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49591.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":101748.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49591.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47737.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":130448.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49591.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110007.27},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46347.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48201.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51538.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":61178.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49591.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":91494.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49128.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46347.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":117818.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143138.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48664.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":133442.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":117818.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46347.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49591.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"458","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32800.03,"maximum":174285.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":61775.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110315.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35096.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":104799.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":72619.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":110064.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":72703.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":77576.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33784.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33784.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":66890.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":124748.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":174285.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":75899.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":92335.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98227.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35096.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71197.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35096.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33784.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":91279.8},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35096.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76976.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32800.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34112.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36473.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43296.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35096.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64750.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34768.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32800.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":82442.23},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100159.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34440.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":93374.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":82442.23},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32800.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35096.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With Mcc","code_information":[{"code":"461","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43017.55,"maximum":230690.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":81768.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146017.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46028.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":138715.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":96122.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":145685.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":96232.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":102683.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44308.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44308.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":88539.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":165121.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":230690.19},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":100463.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":122218.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130016.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46028.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":94238.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46028.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44308.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":120821.15},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46028.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101888.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43017.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44738.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47835.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56783.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46028.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84920.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45598.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43017.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":109123.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132574.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45168.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":123593.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":109123.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43017.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46028.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without Mcc","code_information":[{"code":"462","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21355.26,"maximum":111105.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39381.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70325.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22850.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":66808.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":46294.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70165.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46347.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49454.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21995.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21995.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42642.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":79526.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":111105.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":48385.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":58863.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62619.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22850.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":45387.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22850.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21995.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":58190.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22850.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49071.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22209.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23747.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28188.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22850.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42157.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22636.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52556.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63850.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22423.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":59525.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":52556.28},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22850.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"463","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44353.0,"maximum":238062.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":84381.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150683.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47457.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":143148.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":99194.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":150341.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":99308.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":105965.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45683.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":45683.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":91368.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":170397.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":238062.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":103673.91},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":126124.24},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134171.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47457.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":97250.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47457.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45683.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":124682.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47457.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105144.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46127.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49320.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":58545.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47457.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87557.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47014.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":112610.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136810.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46570.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":127543.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":112610.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44353.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47457.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"464","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24795.65,"maximum":130097.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46113.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82346.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26531.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":78228.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":54208.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":82159.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54270.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":57908.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25539.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25539.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":49931.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":93120.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":130097.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":56656.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":68925.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73323.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26531.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":53146.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26531.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25539.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":68137.18},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26531.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57459.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24795.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25787.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27572.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32730.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26531.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48949.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26283.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24795.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61540.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74765.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26035.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":69700.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":61540.24},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24795.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26531.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridement And Skin Graft Except Hand For Musculoskeletal And Connective Tissue Disorders Wit","code_information":[{"code":"465","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15027.57,"maximum":76174.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26999.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48214.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45804.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31739.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48105.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31776.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33906.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15478.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15478.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29235.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54523.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76174.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33173.1},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40356.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42931.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31117.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15478.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39895.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33643.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15027.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15628.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16710.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19836.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15929.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15027.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36032.66},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43776.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15778.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40810.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36032.66},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15027.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Mcc","code_information":[{"code":"466","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":40614.49,"maximum":217424.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":77065.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137620.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":130738.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":90594.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":137308.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":90698.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":96778.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41832.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":41832.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":83447.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":155625.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":217424.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":94686.23},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":115190.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122540.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":88819.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41832.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":113873.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96029.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40614.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42239.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45163.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":53611.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":80177.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43051.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40614.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":102848.29},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124950.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42645.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":116486.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":102848.29},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40614.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43457.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With Cc","code_information":[{"code":"467","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27912.21,"maximum":147302.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52211.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93236.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29866.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":88574.09},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":61376.95},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":93024.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":61447.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":65566.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":56534.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":105434.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":147302.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64148.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":78040.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83019.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29866.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60174.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29866.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28749.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":77147.9},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29866.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65058.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27912.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29028.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31038.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36844.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29866.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55101.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29586.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27912.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69678.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84652.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29307.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":78918.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":69678.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27912.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29866.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":29359.27,"10th_percentile":29359.27,"90th_percentile":29359.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":90580.03,"10th_percentile":90580.03,"90th_percentile":90580.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement Without Cc/Mcc","code_information":[{"code":"468","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22021.09,"maximum":114781.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40684.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72651.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23562.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":69018.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47826.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72486.74},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47881.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":51090.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22681.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22681.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":44053.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82156.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":114781.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":49986.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":60810.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64690.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23562.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46889.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23562.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22681.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":60115.25},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23562.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50695.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22021.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22901.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24487.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29067.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23562.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43471.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23342.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22021.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54294.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65962.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23122.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":61494.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":54294.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22021.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23562.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without Mcc","code_information":[{"code":"558","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7987.14,"maximum":37308.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13223.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23614.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8546.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22433.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15545.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23560.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15563.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16606.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8226.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8226.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14318.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26704.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37308.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16247.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19765.62},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21026.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8546.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15240.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8546.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8226.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19539.64},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8546.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16477.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7987.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8306.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8881.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10543.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8546.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15767.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8466.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7987.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17647.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21440.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8386.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19988.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17647.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7987.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8546.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15339.3,"maximum":77895.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27609.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49304.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16413.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":46838.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32456.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49192.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32494.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34672.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15799.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15799.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29896.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":55754.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":77895.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33922.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":41268.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43901.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16413.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31820.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16413.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15799.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40796.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16413.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34403.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15339.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15952.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17057.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20247.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16413.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30281.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16259.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15339.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36846.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44765.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16106.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":41732.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36846.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15339.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16413.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Cc","code_information":[{"code":"560","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9749.33,"maximum":47036.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16671.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29771.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10431.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28283.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19598.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29704.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19621.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20936.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10041.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10041.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18052.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33667.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47036.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20483.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24919.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26509.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10431.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19214.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10431.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10041.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24634.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10431.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20774.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9749.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10139.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10841.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12869.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10431.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19246.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10334.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9749.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22249.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27030.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10236.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25199.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22249.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9749.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10431.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without Cc/Mcc","code_information":[{"code":"561","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7311.47,"maximum":33578.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11901.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21253.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7823.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20190.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13991.08},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21205.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14007.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14946.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12887.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24034.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33578.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14622.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17789.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18924.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7823.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13716.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7823.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7530.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17586.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7823.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14830.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7311.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7603.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8130.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9651.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7823.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14433.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7750.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7311.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15883.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19296.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7677.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17989.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15883.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7311.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7823.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12009.38,"maximum":59512.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21094.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37668.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12850.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35785.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24797.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37583.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24825.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26489.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12369.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12369.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22840.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42597.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59512.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25917.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31529.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33541.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12850.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24311.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12850.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12369.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31168.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12850.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26284.71},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12009.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12489.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13354.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15852.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12850.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23707.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12729.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12009.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28151.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34200.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12609.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31884.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28151.2},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12009.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12850.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10063.56,"10th_percentile":10063.56,"90th_percentile":10063.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without Mcc","code_information":[{"code":"563","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8004.54,"maximum":37404.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13257.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23675.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8564.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22491.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15585.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23621.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15603.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16649.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8244.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8244.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14355.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26772.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37404.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16289.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19816.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21080.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8564.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15279.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8564.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8244.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19589.96},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8564.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16520.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8004.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8324.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8901.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10565.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8564.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15801.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8484.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8004.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17693.29},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21495.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8404.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20039.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17693.29},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8004.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8564.86,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7678.92,"10th_percentile":7678.92,"90th_percentile":7678.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10498.22,"10th_percentile":10498.22,"90th_percentile":10498.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4094.64,"10th_percentile":4094.64,"90th_percentile":4094.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Mcc","code_information":[{"code":"564","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12908.25,"maximum":64474.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22853.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40809.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13811.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38769.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26864.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40717.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26895.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28698.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13295.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13295.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24745.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46149.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64474.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28078.08},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34158.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36337.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13811.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26338.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13811.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13295.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33767.79},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13811.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28476.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12908.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13424.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14353.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17038.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13811.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25482.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13682.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12908.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30498.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37052.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13553.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34542.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30498.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12908.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13811.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14250.2,"10th_percentile":14250.2,"90th_percentile":14250.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8601.52,"maximum":40699.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14425.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25761.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24473.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16958.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25702.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16977.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18116.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8859.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8859.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15620.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29131.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40699.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17724.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21562.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22938.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16626.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8859.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21315.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17975.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8601.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8945.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9564.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11354.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9203.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16980.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9117.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8601.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19252.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23389.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9031.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21805.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19252.2},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8601.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9203.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6898.35,"maximum":31297.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11093.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19809.99},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7381.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18819.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13040.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19765.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13055.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13930.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7105.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7105.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12012.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22401.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31297.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13629.77},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16581.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17639.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7381.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12785.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7381.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7105.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16391.69},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7381.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13823.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6898.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7174.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7670.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9105.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7381.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13618.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7312.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6898.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14804.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17986.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7243.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16767.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14804.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6898.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7381.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23482.14,"maximum":122846.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43542.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77756.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25125.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":73868.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":51186.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77580.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51245.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54680.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24186.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24186.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":47148.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":87930.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":122846.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53498.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":65083.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69236.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25125.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":50183.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25125.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24186.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":64339.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25125.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54257.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24421.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26112.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30996.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25125.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46356.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24891.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58110.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70598.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24656.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65815.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":58110.25},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23482.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25125.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14012.18,"maximum":70568.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25013.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44667.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14993.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42433.48},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29404.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44565.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29437.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31411.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27084.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50510.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70568.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30732.01},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37386.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39772.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14993.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28827.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14993.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14432.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36959.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14993.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31167.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14012.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14572.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15581.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18496.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14993.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27661.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14852.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14012.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33381.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40554.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14712.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37807.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33381.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14012.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14993.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without Cc/Mcc","code_information":[{"code":"572","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9902.17,"maximum":47879.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16970.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30305.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10595.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28790.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19950.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30237.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19973.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21312.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10199.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10199.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18376.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34270.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47879.8},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20851.2},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25366.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26985.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10595.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19559.32},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10595.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10199.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25076.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10595.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21146.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9902.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10298.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11011.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13070.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10595.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19547.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10496.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9902.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22648.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27515.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10397.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25651.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22648.6},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9902.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10595.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"573","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50798.72,"maximum":273645.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":96993.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173205.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":164544.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":114020.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":172812.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":114151.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":121803.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":52322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":105025.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":195867.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":273645.43},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":119169.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":144975.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154226.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":111786.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52322.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":143318.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120860.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50798.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52830.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56488.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":67054.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54354.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":100281.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53846.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50798.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":129442.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157259.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53338.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":146607.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":129442.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50798.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54354.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"574","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27494.55,"maximum":144996.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":51394.08},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91776.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29419.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":87187.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":60416.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":91568.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":60485.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":64540.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28319.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28319.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":55650.01},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":103784.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":144996.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":63144.77},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":76818.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81720.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29419.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":59232.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29419.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28319.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":75940.35},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29419.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64040.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27494.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28594.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30573.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36292.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29419.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54276.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29144.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27494.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":68587.92},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83327.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28869.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":77682.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":68587.92},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27494.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29419.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"575","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14825.55,"maximum":75058.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26604.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47509.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15863.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45133.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31274.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47401.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31310.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33409.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15270.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15270.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28807.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53724.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75058.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32687.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39765.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42303.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15863.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30662.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15863.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15270.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39311.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15863.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33151.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15418.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16486.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19569.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15863.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29267.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15715.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35505.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43135.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15566.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40213.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35505.13},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14825.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15863.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Mcc","code_information":[{"code":"576","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38312.83,"maximum":204718.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":72562.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129577.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40994.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":123098.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":85300.48},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":129283.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":85398.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":91123.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39462.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39462.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":78571.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":146531.18},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":204718.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":89152.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":108458.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115379.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40994.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":83629.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40994.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39462.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":107218.65},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40994.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90417.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39845.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42603.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":50572.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40994.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75633.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40611.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":96837.91},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117648.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40228.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":109679.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":96837.91},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38312.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40994.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With Cc","code_information":[{"code":"577","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21284.89,"maximum":110717.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39243.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70079.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22774.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":66574.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":46132.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":69920.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46185.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49281.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21923.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21923.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42493.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":79247.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":110717.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":48216.23},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":58657.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62400.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22774.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":45228.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22774.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21923.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":57986.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22774.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48900.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21284.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22136.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23668.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28096.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22774.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42018.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22561.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21284.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52372.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63627.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22349.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":59317.36},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":52372.53},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21284.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22774.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis Without Cc/Mcc","code_information":[{"code":"578","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13383.42,"maximum":67097.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23782.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42470.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14320.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40346.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27957.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42373.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27989.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29866.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13784.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13784.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25752.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48026.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67097.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29220.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35548.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37816.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14320.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27410.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14320.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13784.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35141.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14320.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29634.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13383.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13918.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14882.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17666.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14320.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26420.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14186.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13383.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31739.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38560.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14052.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35948.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31739.25},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13383.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14320.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25732.36,"maximum":135268.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47945.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85619.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":81338.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":56362.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":85425.15},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":56427.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":60210.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26504.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26504.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51916.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":96821.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":135268.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58908.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":71664.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76237.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":55258.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26504.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":70845.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59743.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25732.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26761.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28614.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33966.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27533.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50798.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27276.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25732.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63986.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77736.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27018.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72471.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63986.28},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25732.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27533.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":33736.09,"10th_percentile":33736.09,"90th_percentile":33736.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Cc","code_information":[{"code":"580","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14303.48,"maximum":72176.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25583.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45684.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15304.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43400.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30074.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45581.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30108.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32126.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14732.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14732.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27701.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51662.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72176.83},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31432.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38238.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40678.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15304.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29484.86},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15304.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14732.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37801.73},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15304.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31878.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14303.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14875.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18880.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15304.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28236.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15161.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14303.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34141.82},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41478.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15018.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38669.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34141.82},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14303.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15304.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without Cc/Mcc","code_information":[{"code":"581","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12147.84,"maximum":60276.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21365.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38152.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12998.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36244.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25115.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38066.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25144.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26830.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12512.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12512.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23134.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43144.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60276.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26249.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31934.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33972.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12998.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24623.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12998.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12512.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31569.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12998.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26622.31},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12147.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12633.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13508.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16035.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12998.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23981.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12876.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12147.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28512.77},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34640.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12755.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32293.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28512.77},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12147.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12998.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15981.27,"10th_percentile":15981.27,"90th_percentile":15981.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy With Cc/Mcc","code_information":[{"code":"582","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15806.14,"maximum":80472.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28523.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50935.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16912.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48388.49},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33530.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50819.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33569.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35819.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16280.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16280.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30885.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57599.56},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80472.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35044.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42633.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45354.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16912.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32873.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16912.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16280.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42146.3},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16912.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35541.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15806.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16438.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17576.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20864.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16912.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31202.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16754.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15806.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38065.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46246.11},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16596.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43113.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38065.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15806.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16912.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mastectomy For Malignancy Without Cc/Mcc","code_information":[{"code":"583","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14276.24,"maximum":72026.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25529.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45589.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15275.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43310.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30011.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45486.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30045.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32060.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14704.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14704.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27643.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51554.39},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72026.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31366.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38159.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40594.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15275.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29423.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15275.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14704.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37722.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15275.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31811.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14276.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14847.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15875.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18844.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15275.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28182.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15132.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14276.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34070.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41392.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14990.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38588.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34070.7},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14276.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15275.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With Cc/Mcc","code_information":[{"code":"584","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17426.09,"maximum":89414.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31693.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56595.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18645.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53765.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37256.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56467.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37299.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39799.89},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17948.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17948.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34317.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64000.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89414.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38939.33},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":47371.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50394.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18645.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36526.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18645.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17948.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46829.95},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18645.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39491.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17426.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18123.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19377.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23002.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18645.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34400.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18471.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17426.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42295.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51385.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18297.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47904.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42295.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17426.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18645.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures Without Cc/Mcc","code_information":[{"code":"585","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15825.06,"maximum":80576.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28560.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51001.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16932.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48451.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33574.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50885.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33612.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35865.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16299.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16299.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30925.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57674.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80576.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35090.33},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42689.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45412.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16932.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32916.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16932.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16299.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42200.99},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16932.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35588.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15825.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16458.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17597.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20889.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16932.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31240.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16774.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15825.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38115.16},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46306.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16616.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43169.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38115.16},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15825.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16932.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Mcc","code_information":[{"code":"592","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15871.97,"maximum":80835.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28652.12},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51165.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16983.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48606.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33681.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51049.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33720.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35981.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16348.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16348.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31024.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57859.66},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80835.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35203.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42826.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45558.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16983.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33022.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16983.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16348.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42336.62},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16983.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35702.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15871.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16506.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17649.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20951.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16983.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31332.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16824.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15871.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38237.66},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46454.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16665.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43308.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38237.66},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15871.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16983.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers With Cc","code_information":[{"code":"593","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10204.82,"maximum":49550.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17563.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31363.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29795.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20646.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31292.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20670.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22055.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10510.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10510.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19017.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35466.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49550.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21578.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26251.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27926.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20241.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10510.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25951.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21884.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10204.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10613.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11347.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13470.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10919.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20145.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10817.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10204.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23438.92},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28475.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10715.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26547.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23438.92},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10204.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10919.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without Cc/Mcc","code_information":[{"code":"594","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7787.39,"maximum":36205.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12832.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22916.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8332.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21770.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15085.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22864.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15103.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16115.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8021.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8021.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13895.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25914.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36205.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15767.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19181.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20405.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8332.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14790.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8332.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8021.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18962.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8332.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15990.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7787.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8098.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8659.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10279.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8332.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15373.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8254.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7787.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17126.23},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20806.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8176.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19397.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17126.23},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7787.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8332.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With Mcc","code_information":[{"code":"595","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17274.76,"maximum":88579.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31396.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56067.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18483.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53263.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36908.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55939.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36951.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39428.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17793.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17793.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33996.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63402.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88579.52},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38575.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46928.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49923.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18483.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36185.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18483.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17793.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46392.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18483.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39122.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17965.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19209.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22802.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18483.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34102.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18311.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41900.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50905.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18138.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47457.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41900.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17274.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18483.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders Without Mcc","code_information":[{"code":"596","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9419.44,"maximum":45214.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16026.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28619.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10078.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27188.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18839.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28554.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18861.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20125.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17353.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32363.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45214.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19690.68},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23954.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25483.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10078.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18470.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10078.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9702.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23680.77},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10078.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19969.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9419.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9796.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10474.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12433.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10078.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18594.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9984.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9419.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21388.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25984.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9890.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24224.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21388.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9419.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10078.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Mcc","code_information":[{"code":"597","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13842.69,"maximum":69633.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24681.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44074.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14811.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41870.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29014.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43974.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29047.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30994.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14257.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14257.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26725.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49841.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69633.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30324.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36891.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39245.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14811.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28445.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14811.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14257.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36469.48},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14811.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30754.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13842.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14396.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15393.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18272.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14811.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27326.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14673.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13842.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32938.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40017.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14534.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37306.36},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32938.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13842.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14811.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With Cc","code_information":[{"code":"598","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9788.67,"maximum":47253.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16748.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29909.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10473.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28413.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19689.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29841.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19711.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21033.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10082.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10082.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18135.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33822.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47253.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20578.35},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25034.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26631.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10473.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19303.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10473.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10082.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24748.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10473.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20870.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9788.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10180.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10885.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12921.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10473.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19323.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10375.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9788.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22352.23},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27155.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10278.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25316.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22352.23},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9788.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10473.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without Cc/Mcc","code_information":[{"code":"599","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7050.43,"maximum":32137.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11390.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20341.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7543.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19324.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13390.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20295.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13406.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14304.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7261.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7261.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12334.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23002.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32137.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13995.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17026.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18112.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7543.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13128.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7543.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7261.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16831.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7543.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14193.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7050.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7332.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7840.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9306.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7543.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13918.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7473.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7050.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15201.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18468.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7402.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17217.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15201.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7050.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7543.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without Cc/Mcc","code_information":[{"code":"244","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14905.0,"maximum":75497.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26760.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47786.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15948.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45397.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31457.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47678.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31493.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33605.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15352.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15352.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28976.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54038.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75497.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32878.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39998.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42550.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15948.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30841.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15948.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15352.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39540.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15948.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33344.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14905.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15501.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16574.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19674.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15948.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29423.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15799.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14905.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35712.59},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43387.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15650.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40448.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35712.59},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14905.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15948.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5882.55,"10th_percentile":5882.55,"90th_percentile":5882.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16458.69,"10th_percentile":16458.69,"90th_percentile":16458.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Cc","code_information":[{"code":"243","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17351.94,"maximum":89005.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31547.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56336.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18566.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53519.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37086.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56208.88},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37128.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39617.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17872.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17872.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34160.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63707.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89005.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38761.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":47154.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50163.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18566.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36359.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18566.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17872.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46615.57},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18566.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39310.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17351.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18046.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19295.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22904.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18566.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34254.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18393.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17351.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42102.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51150.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18219.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47685.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42102.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17351.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18566.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With Mcc","code_information":[{"code":"242","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25386.58,"maximum":133360.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47269.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84411.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27163.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":80190.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":55567.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":84219.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55631.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59360.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26148.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26148.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51183.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":95455.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":133360.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58077.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":70653.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75161.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27163.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":54478.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27163.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26148.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":69845.69},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27163.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58900.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25386.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26402.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28229.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33510.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27163.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50115.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26909.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25386.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63083.34},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76639.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26655.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71448.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63083.34},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25386.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27163.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without Cc/Mcc","code_information":[{"code":"241","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11703.7,"maximum":57825.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20496.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36600.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12522.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34770.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24094.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36517.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24121.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25738.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12054.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12054.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22193.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41389.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57825.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25182.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30635.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32590.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12522.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23622.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12522.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12054.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30285.13},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12522.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25539.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11703.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12171.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13014.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15448.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12522.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23104.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12405.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11703.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27352.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33231.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12288.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30980.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27352.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11703.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12522.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Cc","code_information":[{"code":"240","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22796.64,"maximum":119062.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42201.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75361.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24392.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":71593.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":49610.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":75190.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":49667.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":52996.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23480.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23480.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":45696.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":85221.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":119062.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":51850.6},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":63078.71},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67103.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24392.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":48638.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24392.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23480.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":62357.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24392.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52586.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22796.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23708.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25349.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30091.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24392.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45002.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24164.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22796.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56320.18},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68423.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23936.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":63788.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":56320.18},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22796.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24392.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With Mcc","code_information":[{"code":"239","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38467.94,"maximum":205574.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":72865.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130119.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41160.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":123613.42},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":85657.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":129824.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":85755.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":91504.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39621.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39621.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":78899.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":147144.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":205574.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":89525.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":108912.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115861.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41160.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":83978.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41160.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39621.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":107667.11},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41160.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90795.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38467.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40006.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42776.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":50777.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41160.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75939.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40776.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38467.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":97242.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118140.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40391.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":110137.8},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":97242.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38467.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41160.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization Without Mcc","code_information":[{"code":"236","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32922.6,"maximum":174961.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62015.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110743.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35227.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":105205.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":72901.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":110492.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":72985.65},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":77878.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67150.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":125232.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":174961.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":76194.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":92693.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98608.54},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35227.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71473.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35227.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33910.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":91634.19},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35227.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77274.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32922.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34239.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36609.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43457.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35227.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64992.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34897.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32922.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":82762.31},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100547.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34568.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":93736.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":82762.31},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32922.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35227.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass Without Cardiac Catheterization With Mcc","code_information":[{"code":"235","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45632.46,"maximum":245125.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":86884.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155154.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48826.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":147395.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":102137.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":154801.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":102254.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":109109.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47001.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47001.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":94079.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":175453.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":245125.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":106749.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":129866.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138152.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48826.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100135.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48826.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47001.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":128381.49},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48826.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108263.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45632.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47457.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50743.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":60234.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48826.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":90083.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48370.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45632.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":115951.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140869.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47914.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":131327.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":115951.8},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45632.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48826.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation Without Mcc","code_information":[{"code":"234","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42561.3,"maximum":228171.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80875.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144422.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45540.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":137201.17},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":95072.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":144095.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":95182.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":101562.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43838.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43838.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":87572.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":163318.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":228171.52},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":99366.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":120884.09},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128597.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45540.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":93210.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45540.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43838.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":119502.03},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45540.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100775.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42561.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44263.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47328.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56180.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45540.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84020.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45114.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42561.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":107932.03},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131126.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44689.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":122244.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":107932.03},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42561.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45540.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Cardiac Catheterization Or Open Ablation With Mcc","code_information":[{"code":"233","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59074.73,"maximum":319332.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":113187.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202123.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63209.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":192016.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":133057.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":201665.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":133209.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":142139.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60846.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":60846.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":122560.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":228568.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":319332.36},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":139066.19},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":169180.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179975.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63209.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":130450.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63209.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60846.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":167246.4},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63209.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141038.65},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59074.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61437.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65691.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":77978.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63209.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":116619.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62619.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59074.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":151053.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183515.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62028.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":171084.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":151053.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59074.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63209.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca Without Mcc","code_information":[{"code":"232","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47100.32,"maximum":253228.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":89756.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160283.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50397.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":152268.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":105513.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":159919.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":105634.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":112715.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48513.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":48513.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":97189.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":181253.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":253228.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":110278.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":134159.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142719.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50397.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":103446.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50397.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48513.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":132625.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50397.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111842.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47100.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48984.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52375.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":62172.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50397.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92980.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49926.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47100.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":119784.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145526.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49455.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":135668.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":119784.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47100.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50397.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass With Ptca With Mcc","code_information":[{"code":"231","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65012.0,"maximum":352108.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":124804.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":222869.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69562.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":211725.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":146713.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":222363.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":146882.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":156728.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66962.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":66962.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":135139.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":252028.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":352108.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":153339.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":186545.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198448.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69562.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":143839.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69562.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66962.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":184412.49},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69562.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155514.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65012.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67612.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72293.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":85815.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69562.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128340.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68912.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65012.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":166557.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202351.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68262.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":188644.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":166557.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65012.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69562.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without Mcc","code_information":[{"code":"229","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25058.96,"maximum":131551.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46628.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83266.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26813.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":79102.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":54813.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83077.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54876.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58555.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25810.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25810.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50489.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":94160.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":131551.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57289.41},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":69695.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74142.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26813.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":53739.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26813.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25810.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":68898.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26813.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58101.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25058.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26061.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27865.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33077.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26813.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49468.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26562.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25058.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62227.82},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75600.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26311.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70479.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62227.82},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25058.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26813.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27668.54,"10th_percentile":27668.54,"90th_percentile":27668.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With Mcc","code_information":[{"code":"228","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38662.39,"maximum":206647.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":73246.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130799.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":124258.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":86104.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":130502.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":86203.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":91982.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39822.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39822.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":79311.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":147912.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":206647.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":89993.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":109481.01},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116466.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":84417.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39822.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":108229.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91269.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40208.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42992.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":51034.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41368.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76323.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40982.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":97750.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118757.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40595.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":110712.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":97750.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38662.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41368.76,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42691.87,"10th_percentile":42691.87,"90th_percentile":42691.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization Without Cc/M","code_information":[{"code":"221","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39364.54,"maximum":210524.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74620.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133252.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42120.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":126589.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":87719.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":132950.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":87820.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":93707.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40545.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":40545.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":80799.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":150686.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":210524.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":91681.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":111534.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118651.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42120.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":86000.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42120.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40545.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":110259.42},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42120.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92981.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39364.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40939.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43773.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":51961.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42120.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":77709.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41726.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39364.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":99584.27},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120984.96},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41332.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":112789.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":99584.27},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39364.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42120.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Cc","code_information":[{"code":"220","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41578.44,"maximum":222745.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78952.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140988.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44488.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":133938.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":92812.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":140668.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":92918.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":99147.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42825.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":42825.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":85490.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":159434.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":222745.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":97003.63},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":118009.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125539.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44488.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":90993.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44488.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42825.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":116660.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44488.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98379.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41578.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43241.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46235.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":54883.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44488.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":82080.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44073.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41578.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":105365.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128008.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43657.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":119337.4},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":105365.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41578.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44488.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With Mcc","code_information":[{"code":"219","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":59325.17,"maximum":320714.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":113677.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202998.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63477.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":192848.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":133633.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":202538.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":133786.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":142754.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61104.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":61104.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":123090.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":229558.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":320714.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":139668.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":169913.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":180754.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63477.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":131014.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63477.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61104.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":167970.49},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63477.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141649.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59325.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61698.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65969.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":78309.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63477.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":117113.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62884.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59325.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":151707.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184309.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62291.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":171825.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":151707.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59325.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63477.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without Cc/Mcc","code_information":[{"code":"218","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50979.55,"maximum":274643.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":97347.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173837.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":165145.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":114436.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":173443.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":114568.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":122247.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52508.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":52508.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":105408.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":196581.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":274643.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":119604.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":145504.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154789.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":112194.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52508.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":143841.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121301.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50979.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53018.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56689.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":67293.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":100638.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54038.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50979.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":129914.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157833.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53528.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":147142.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":129914.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50979.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Cc","code_information":[{"code":"217","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":50979.55,"maximum":274643.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":97347.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173837.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":165145.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":114436.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":173443.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":114568.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":122247.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52508.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":52508.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":105408.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":196581.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":274643.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":119604.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":145504.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154789.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":112194.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52508.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":143841.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121301.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50979.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53018.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56689.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":67293.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":100638.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54038.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50979.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":129914.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157833.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53528.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":147142.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":129914.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50979.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54548.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization With Mcc","code_information":[{"code":"216","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":75248.43,"maximum":408617.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":144834.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":258637.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":245704.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":170259.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":258050.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":170455.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":181881.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77505.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":77505.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":156828.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":292476.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":408617.77},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":177949.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":216483.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":230296.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":166923.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77505.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":214008.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":180473.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75248.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78258.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83676.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":99327.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80515.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":148547.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79763.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75248.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":193288.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":234826.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79010.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":218919.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":193288.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75248.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80515.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Heart Assist System Implant","code_information":[{"code":"215","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":76566.48,"maximum":415893.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":147413.39},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263243.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81926.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":250080.01},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":173291.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":262645.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":173490.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":185120.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78863.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":78863.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":159620.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":297684.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":415893.93},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":181117.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":220338.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":234397.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81926.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":169896.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81926.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78863.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":217819.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81926.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183686.74},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76566.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79629.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85141.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":101067.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81926.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":151149.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81160.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76566.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":196730.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":239007.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80394.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":222817.75},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":196730.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76566.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81926.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Abdominal Aorta With Iliac Branch Procedures","code_information":[{"code":"213","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44408.99,"maximum":238371.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":84490.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150879.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47517.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":143334.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":99322.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":150536.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":99437.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":106102.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45741.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":45741.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":91487.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":170619.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":238371.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":103808.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":126287.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134346.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47517.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":97376.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47517.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45741.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":124844.14},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47517.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105280.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44408.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46185.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49382.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":58619.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47517.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87667.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47073.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44408.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":112756.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136988.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46629.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":127709.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":112756.93},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44408.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47517.62,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Aortic And Mitral Valve Procedures","code_information":[{"code":"212","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":83505.52,"maximum":454200.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":160991.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":287489.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89350.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":273113.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":189252.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":286837.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":189470.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":202171.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86010.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":86010.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":174322.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":325102.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":454200.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":197799.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":240632.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255987.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89350.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":185544.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89350.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86010.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":237881.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89350.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":200605.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83505.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86845.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92858.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":110227.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89350.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":164848.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88515.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83505.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":214850.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261021.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87680.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":243340.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":214850.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83505.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89350.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86870.25,"maximum":472774.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":167574.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299246.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92951.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":284282.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":196992.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":298567.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":197218.77},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":210439.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89476.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":89476.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":181451.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":338398.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":472774.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":205888.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":250473.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266455.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92951.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":193132.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92951.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89476.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":247610.07},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92951.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208809.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86870.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90345.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96599.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":114668.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92951.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":171490.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92082.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86870.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":223636.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":271696.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91213.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":253292.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":223636.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86870.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92951.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 Hours","code_information":[{"code":"208","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22026.39,"maximum":114810.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40694.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72670.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23568.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":69036.35},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47838.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72505.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47893.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":51103.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22687.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22687.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":44064.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82177.88},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":114810.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":49998.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":60825.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64707.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23568.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46901.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23568.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22687.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":60130.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23568.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50708.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22907.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24493.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29074.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23568.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43482.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23347.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54308.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65979.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23127.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":61510.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":54308.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23568.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":23179.31,"10th_percentile":23179.31,"90th_percentile":23179.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support >96 Hours","code_information":[{"code":"207","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":49915.73,"maximum":268770.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":95265.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":170120.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53409.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":161613.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":111989.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":169734.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":112118.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":119633.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51413.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":51413.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":103154.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":192378.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":268770.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":117047.19},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":142393.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151479.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53409.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":109795.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53409.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51413.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":140765.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53409.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118707.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49915.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51912.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55506.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":65888.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53409.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":98538.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52910.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49915.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":127136.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154458.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52411.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":143995.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":127136.8},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49915.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53409.83,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":52672.52,"10th_percentile":52672.52,"90th_percentile":52672.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without Mcc","code_information":[{"code":"206","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8349.57,"maximum":39308.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13932.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24880.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8934.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23636.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16378.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24824.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16397.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17496.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8600.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8600.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15086.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28136.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39308.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17118.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20825.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22154.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8934.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16057.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8934.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8600.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20587.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8934.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17361.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8683.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9284.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11021.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8934.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16482.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8850.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18594.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22590.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8767.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21059.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18594.25},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8349.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8934.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15082.81,"maximum":76479.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27107.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48407.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16138.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45987.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31866.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48298.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31903.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34041.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15535.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15535.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29352.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54741.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76479.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33305.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40518.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43103.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16138.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31242.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16138.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15535.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40054.96},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16138.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33778.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15082.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15686.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16772.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19909.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16138.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29774.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15987.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15082.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36176.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43951.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15836.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40974.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36176.9},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15082.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16138.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7337.95,"maximum":33724.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11953.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21346.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7851.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20278.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14051.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21297.6},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14068.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15011.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7558.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7558.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12943.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24138.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33724.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14686.61},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17866.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19007.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7851.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13776.67},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7851.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7558.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17662.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7851.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14894.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7337.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7631.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8159.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9686.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7851.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14485.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7778.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7337.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15952.61},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19380.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7704.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18068.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15952.61},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7337.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7851.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7058.73,"10th_percentile":7058.73,"90th_percentile":7058.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6298.34,"maximum":27985.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9919.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17713.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16827.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11660.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17673.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11674.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12456.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6487.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6487.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10740.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20030.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27985.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12187.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14826.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15772.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11432.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6487.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14656.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12360.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6550.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7003.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8313.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6739.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12433.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6676.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13237.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16082.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6613.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14993.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13237.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6298.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6739.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8577.31,"maximum":40566.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14378.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25676.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9177.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24392.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16902.76},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25618.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16922.19},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18056.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8834.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8834.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15569.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29035.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40566.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17666.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21491.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22863.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9177.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16571.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9177.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8834.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21245.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9177.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17916.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8577.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8920.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9537.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11322.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9177.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16932.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9091.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8577.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19188.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23312.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9006.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21733.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19188.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8577.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9177.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":13254.95,"10th_percentile":13254.95,"90th_percentile":13254.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9469.38,"10th_percentile":9469.38,"90th_percentile":9472.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":10257.83,"10th_percentile":10257.83,"90th_percentile":10257.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7301.05,"10th_percentile":7301.05,"90th_percentile":7301.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without Cc/Mcc","code_information":[{"code":"201","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6639.58,"maximum":29869.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10587.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18905.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7104.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17960.45},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12445.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18862.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12459.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13295.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6838.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6838.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11463.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21379.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29869.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13007.67},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15824.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16834.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7104.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12201.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7104.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6838.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15643.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7104.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13192.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6639.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6905.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7383.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8764.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7104.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13107.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7037.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6639.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14128.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17165.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6971.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16002.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14128.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6639.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7104.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Cc","code_information":[{"code":"200","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9546.55,"maximum":45916.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16275.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29063.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10214.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27610.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19132.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28997.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19154.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20438.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9832.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9832.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17622.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32865.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45916.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19996.27},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24326.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25878.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10214.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18757.36},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10214.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9832.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24048.29},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10214.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20279.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9546.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9928.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10615.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12601.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10214.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18845.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10119.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9546.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21719.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26387.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10023.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24600.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21719.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9546.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10214.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":9460.73,"10th_percentile":9460.73,"90th_percentile":9460.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax With Mcc","code_information":[{"code":"199","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14576.62,"maximum":73684.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26117.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46639.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15596.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44307.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30702.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46533.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30737.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32798.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15013.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15013.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28280.29},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52741.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73684.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32088.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39037.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41528.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15596.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30100.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15596.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15013.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38591.45},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15596.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32544.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14576.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15159.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16209.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19241.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15596.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28775.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15451.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14576.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34855.09},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42345.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15305.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39477.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34855.09},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14576.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15596.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":24737.68,"10th_percentile":24737.68,"90th_percentile":24737.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease Without Cc/Mcc","code_information":[{"code":"198","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6647.91,"maximum":29914.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10603.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18934.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7113.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17988.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12464.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18891.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12479.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13315.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6847.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6847.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11481.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21412.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29914.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13027.68},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15848.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16860.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7113.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12220.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7113.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6847.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15667.59},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7113.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13212.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6647.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6913.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7392.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8775.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7113.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13123.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7046.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6647.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14150.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17191.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6980.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16027.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14150.68},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6647.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7113.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Cc","code_information":[{"code":"197","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8410.1,"maximum":39642.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14051.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25092.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8998.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23837.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16518.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25035.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16537.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17645.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8662.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8662.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15215.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28375.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39642.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17264.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21002.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22342.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8998.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16194.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8998.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8662.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20762.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8998.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17509.0},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8410.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8746.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9352.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11101.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8998.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16602.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8914.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8410.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18752.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22782.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8830.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21238.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18752.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8410.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8998.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures With Cc","code_information":[{"code":"818","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9999.77,"maximum":48418.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17161.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30646.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10699.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29114.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20174.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30577.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20197.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21551.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10299.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10299.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18583.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34656.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48418.62},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21085.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25651.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27288.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10699.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19779.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10699.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10299.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25358.66},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10699.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21384.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9999.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10399.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11119.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13199.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10699.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19740.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10599.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9999.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22903.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27825.44},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10499.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25940.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22903.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9999.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10699.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"819","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7735.18,"maximum":35917.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12730.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22734.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21597.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14965.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22682.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14982.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15987.26},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7967.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7967.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13785.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25708.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35917.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15641.58},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19028.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20242.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14672.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7967.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18811.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15863.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7735.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8044.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8601.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10210.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8276.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15270.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8199.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7735.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16989.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20641.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8121.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19242.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16989.9},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7735.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8276.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Mcc","code_information":[{"code":"820","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":45603.71,"maximum":244966.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":86828.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155053.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":147300.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":102070.98},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":154701.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":102188.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":109038.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46971.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46971.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":94018.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":175339.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":244966.83},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":106680.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":129782.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138063.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":100071.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46971.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":128298.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108193.83},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45603.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47427.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50711.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":60196.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48795.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":90026.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48339.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45603.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":115876.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140778.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47883.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":131242.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":115876.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45603.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48795.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures With Cc","code_information":[{"code":"821","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18166.83,"maximum":93504.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33142.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59184.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19438.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":56224.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38960.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59049.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39005.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41620.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18711.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18711.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35887.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66927.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":93504.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40720.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":49537.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52698.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19438.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38197.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19438.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18711.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":48971.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19438.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41297.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18893.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20201.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23980.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19438.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35863.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19256.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44230.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53735.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19075.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50095.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44230.26},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18166.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19438.51,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Leukemia With Major O.R. Procedures Without Cc/Mcc","code_information":[{"code":"822","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10338.74,"maximum":50289.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17825.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31831.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30239.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20954.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31759.11},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20978.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22384.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10648.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10648.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19301.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35995.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50289.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21900.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26643.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28343.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20543.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10648.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26338.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22211.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10338.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10752.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11496.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13647.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20409.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10959.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10338.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23788.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28900.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10855.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26943.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23788.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10338.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11062.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Mcc","code_information":[{"code":"823","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35918.86,"maximum":191502.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67877.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121212.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38433.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":115151.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":79793.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":120937.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":79885.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":85240.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36996.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36996.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":73498.93},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":137071.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":191502.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":83397.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":101457.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107930.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38433.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":78230.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38433.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36996.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":100297.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38433.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84580.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35918.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37355.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39941.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47412.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38433.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70907.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38073.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35918.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90586.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110053.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37714.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":102598.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":90586.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35918.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38433.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With Cc","code_information":[{"code":"824","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18371.12,"maximum":94631.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33542.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59897.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19657.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":56902.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39430.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59762.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39475.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42122.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18922.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18922.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36319.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67734.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94631.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41211.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":50135.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53334.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19657.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38657.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19657.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18922.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":49562.27},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19657.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41795.79},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18371.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19105.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20428.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24249.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19657.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36266.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19473.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18371.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44763.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54383.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19289.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50699.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44763.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18371.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19657.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures Without Cc/Mcc","code_information":[{"code":"825","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11438.88,"maximum":56363.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19977.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35675.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12239.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33891.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23484.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35594.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23511.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25088.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11782.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11782.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21632.23},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40343.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56363.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24545.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29860.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31766.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12239.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23024.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12239.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11782.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29519.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12239.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24893.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11438.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11896.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12720.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15099.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12239.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22581.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12125.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11438.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26661.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32391.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12010.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30196.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26661.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11438.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12239.6,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36622.52,"maximum":195387.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69254.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123671.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39186.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":117487.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":81412.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":123391.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":81505.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":86969.66},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37721.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37721.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":74989.81},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":139852.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":195387.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":85089.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":103515.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110120.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39186.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":79817.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39186.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37721.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":102331.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39186.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86296.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36622.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38087.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40724.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":48341.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39186.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72296.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38819.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36622.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":92423.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112285.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38453.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":104679.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":92423.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36622.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39186.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures With Cc","code_information":[{"code":"827","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18716.14,"maximum":96536.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34217.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61103.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20026.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":58048.1},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40224.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60964.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40270.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42969.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19277.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19277.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37050.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69097.95},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":96536.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42040.73},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":51144.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54407.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20026.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39436.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20026.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19277.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":50559.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20026.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42637.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18716.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19464.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20812.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24705.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20026.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36947.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19839.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18716.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45664.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55478.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19651.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":51720.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45664.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18716.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20026.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Major O.R. Procedures Without C","code_information":[{"code":"828","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14120.37,"maximum":71166.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25224.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45045.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15108.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42792.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29652.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44942.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29687.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31677.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14543.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14543.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27313.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50938.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71166.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30992.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37703.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40109.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15108.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29071.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15108.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14543.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37272.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15108.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31431.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14685.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15701.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18638.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15108.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27875.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14967.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33663.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40898.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14826.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38127.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33663.68},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14120.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15108.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures With Cc/Mcc","code_information":[{"code":"829","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25138.41,"maximum":131990.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46783.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83544.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26898.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":79366.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":54996.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83354.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55059.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":58750.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25892.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25892.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50657.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":94474.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":131990.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57480.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":69927.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74389.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26898.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":53919.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26898.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25892.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":69128.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26898.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58295.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25138.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26143.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27953.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33182.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26898.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49625.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26646.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25138.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62435.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75852.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26395.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":70714.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62435.28},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25138.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26898.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Myeloproliferative Disorders Or Poorly Differentiated Neoplasms With Other Procedures Without Cc/Mcc","code_information":[{"code":"830","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12616.2,"maximum":62862.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22281.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39789.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13499.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37799.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26193.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39698.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26223.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27980.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12994.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12994.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24126.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44994.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62862.35},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27375.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33304.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35429.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13499.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25679.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13499.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12994.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32923.38},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13499.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27764.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12616.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13120.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14029.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16653.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13499.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24905.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13373.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12616.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29735.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36126.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13247.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33678.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29735.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12616.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13499.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Mcc","code_information":[{"code":"831","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10327.39,"maximum":50227.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17803.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31791.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11050.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30201.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20928.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31719.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20952.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22356.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10637.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10637.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19277.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35951.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50227.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21873.48},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26610.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28308.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11050.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20518.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11050.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10637.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26305.89},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11050.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22183.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10327.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10740.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11484.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13632.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11050.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20387.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10947.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10327.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23759.0},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28864.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10843.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26909.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23759.0},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10327.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11050.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":6543.02,"10th_percentile":6543.02,"90th_percentile":6543.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures With Cc","code_information":[{"code":"832","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6688.76,"maximum":30140.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10683.29},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19077.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7156.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18123.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12558.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19034.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12573.16},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13415.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6889.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6889.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11567.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21573.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30140.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13125.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15968.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16987.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7156.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12312.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7156.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6889.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15785.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7156.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13312.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6688.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6956.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7437.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8829.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7156.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13204.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7090.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6688.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14257.37},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17321.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7023.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16147.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14257.37},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6688.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7156.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses Without O.R. Procedures Without Cc/Mcc","code_information":[{"code":"833","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5185.34,"maximum":21841.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":7741.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13824.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5548.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13133.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9100.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":13793.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9111.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":9721.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8382.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":15633.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":21841.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":9511.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":11571.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12309.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5548.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":8922.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5548.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5340.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":11438.96},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5548.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9646.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5185.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5392.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5766.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6844.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5548.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10236.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5496.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5185.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10331.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12551.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5444.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":11701.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10331.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5185.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5548.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Mcc","code_information":[{"code":"834","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42767.1,"maximum":229307.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":81277.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145141.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45760.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":137884.33},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":95546.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":144812.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":95656.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":102068.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44050.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44050.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":88008.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":164131.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":229307.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":99861.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":121486.0},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129237.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45760.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":93674.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45760.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44050.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":120097.05},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45760.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101277.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42767.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44477.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47557.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56452.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45760.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84426.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45333.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42767.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":108469.44},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131779.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44905.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":122852.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":108469.44},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42767.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45760.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Cc","code_information":[{"code":"835","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17010.7,"maximum":87121.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30880.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55144.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18201.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52386.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36301.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55019.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36342.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38779.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17521.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17521.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33437.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62359.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87121.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37940.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46156.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49101.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18201.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35590.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18201.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17521.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45628.96},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18201.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38478.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17010.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17691.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18915.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22454.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18201.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33580.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18031.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17010.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41211.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50067.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17861.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46676.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41211.24},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17010.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18201.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia Without Cc/Mcc","code_information":[{"code":"836","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10456.02,"maximum":50937.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18054.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32241.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11187.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30628.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21224.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32167.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21248.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22672.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10769.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10769.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19549.8},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36459.39},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50937.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22182.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26986.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28708.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11187.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20808.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11187.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10769.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26677.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11187.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22497.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10456.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10874.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11627.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13801.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11187.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20641.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11083.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10456.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24094.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29272.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10978.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27289.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24094.88},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10456.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11187.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy With Acute Leukemia As Secondary Diagnosis Or With High Dose Chemotherapy Agent With Mc","code_information":[{"code":"837","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37579.66,"maximum":200670.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":71127.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127016.08},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40210.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":120664.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":83614.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":126727.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":83710.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":89321.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38707.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38707.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":77017.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":143634.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":200670.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":87390.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":106314.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113098.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40210.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":81975.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40210.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38707.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":105098.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40210.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88629.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37579.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39082.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41788.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":49605.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40210.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":74186.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39834.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37579.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":94923.36},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":115322.42},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39458.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":107510.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":94923.36},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37579.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40210.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8873.91,"maximum":42203.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14958.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26712.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9495.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25377.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17585.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26652.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17605.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18785.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9140.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9140.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16197.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30207.93},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42203.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18379.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22359.14},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23785.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9495.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17240.46},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9495.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9140.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22103.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9495.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18639.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8873.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9228.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9867.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11713.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9495.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17517.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9406.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8873.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19963.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24253.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9317.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22610.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19963.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8873.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9495.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16322.16,"maximum":83320.8,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29533.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52738.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17464.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50101.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34717.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52618.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34757.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37087.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16811.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16811.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31978.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59638.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83320.8},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36285.41},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44142.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46959.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17464.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34037.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17464.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16811.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43638.24},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17464.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36800.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16322.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16975.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18150.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21545.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17464.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32221.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17301.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16322.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39413.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47883.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17138.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44639.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39413.26},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16322.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17464.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10440.13,"maximum":50849.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18023.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32185.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11170.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30576.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21187.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32112.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21211.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22633.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10753.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10753.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19516.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36396.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50849.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22144.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26939.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28658.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11170.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20772.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11170.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10753.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26631.84},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11170.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22458.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10440.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10857.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11609.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13780.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11170.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20609.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11066.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10440.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24053.39},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29222.47},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10962.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27242.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24053.39},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10440.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11170.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses Without Cc/Mcc","code_information":[{"code":"845","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7672.38,"maximum":35570.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12607.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22514.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8209.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21388.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14821.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22463.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14838.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15832.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7902.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7902.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13652.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25460.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35570.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15490.6},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18845.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20047.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8209.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14530.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8209.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7902.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18629.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8209.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15710.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7672.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7979.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8531.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10127.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8209.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15146.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8132.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7672.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16825.91},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20441.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8056.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19057.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16825.91},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7672.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8209.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Mcc","code_information":[{"code":"846","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20844.54,"maximum":108286.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38381.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68540.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22303.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":65113.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":45119.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68384.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":45171.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":48199.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21469.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21469.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41560.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77507.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":108286.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47157.58},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":57369.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61030.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22303.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":44235.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22303.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21469.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":56713.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22303.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47826.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20844.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21678.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23179.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27514.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22303.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41149.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22095.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20844.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":51222.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62230.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21886.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":58014.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":51222.62},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20844.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22303.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis With Cc","code_information":[{"code":"847","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11127.15,"maximum":54642.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19367.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34586.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11906.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32856.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22767.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34507.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22794.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24322.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11460.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11460.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20971.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39111.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54642.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23796.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28949.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30796.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11906.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22321.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11906.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11460.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28618.18},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11906.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24133.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11572.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12373.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14687.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11906.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21966.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11794.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25847.42},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31402.03},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11683.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29274.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25847.42},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11127.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11906.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chemotherapy Without Acute Leukemia As Secondary Diagnosis Without Cc/Mcc","code_information":[{"code":"848","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7655.74,"maximum":35478.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12575.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22456.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8191.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21333.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14782.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22405.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14799.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15792.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7885.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7885.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13616.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25394.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35478.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15450.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18796.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19995.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8191.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14493.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8191.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7885.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18581.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8191.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15669.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7655.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7961.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8513.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10105.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8191.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15113.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8115.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7655.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16782.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20389.0},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8038.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19007.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16782.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7655.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8191.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Radiotherapy","code_information":[{"code":"849","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21729.79,"maximum":113173.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40114.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71633.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23250.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68051.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47156.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":71471.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47210.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50375.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43435.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81005.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":113173.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":49285.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":59958.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63784.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23250.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46232.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23250.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22381.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":59273.02},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23250.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49984.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21729.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22598.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24163.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28683.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23250.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42896.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23033.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21729.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":53534.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65038.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22816.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":60633.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":53534.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21729.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23250.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With Other Procedures","code_information":[{"code":"850","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":66749.22,"maximum":361698.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":128203.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228939.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71421.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":217492.0},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":150709.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":228420.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":150883.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":160997.42},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68751.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":68751.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":138820.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":258893.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":361698.66},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":157516.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":191626.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":203853.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71421.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":147757.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71421.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68751.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":189435.22},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71421.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":159750.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66749.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69419.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74225.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":88108.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71421.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":131769.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70754.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66749.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":171094.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207862.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70086.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":193782.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":171094.4},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66749.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71421.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Mcc","code_information":[{"code":"853","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":38595.81,"maximum":206280.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":73115.97},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130566.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":124037.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":85951.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":130270.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":86050.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":91818.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39753.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39753.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":79170.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":147649.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":206280.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":89833.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":109286.28},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116259.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":84267.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39753.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":108036.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91107.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40139.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42918.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":50946.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41297.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76191.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40911.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":97576.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118546.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40525.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":110515.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":97576.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38595.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41297.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":41294.26,"10th_percentile":41294.26,"90th_percentile":41294.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38001.41,"10th_percentile":38001.41,"90th_percentile":38001.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures With Cc","code_information":[{"code":"854","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16347.13,"maximum":83458.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29581.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52825.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17491.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50184.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34774.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52705.88},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34814.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37148.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16837.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16837.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32031.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59737.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83458.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36345.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44215.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47037.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17491.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34093.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17491.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16837.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43710.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17491.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36860.95},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16347.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17001.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18178.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21578.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17491.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32270.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17327.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16347.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39478.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47962.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17164.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44713.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39478.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16347.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17491.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":33408.06,"10th_percentile":33408.06,"90th_percentile":33408.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7874.71,"10th_percentile":7874.71,"90th_percentile":7874.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":14647.97,"10th_percentile":14647.97,"90th_percentile":14647.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Infectious And Parasitic Diseases With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"855","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12557.18,"maximum":62536.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22166.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39582.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13436.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37603.68},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26057.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39493.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26087.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27835.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12933.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12933.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24001.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44761.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62536.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27234.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33131.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35245.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13436.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25546.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13436.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12933.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32752.75},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13436.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27620.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12557.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13059.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13963.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16575.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13436.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24789.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13310.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12557.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29581.68},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35938.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13185.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33504.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29581.68},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12557.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13436.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35645.71,"maximum":189994.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67343.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120258.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38140.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":114245.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":79165.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":119985.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":79256.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":84569.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36715.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36715.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":72920.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":135992.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":189994.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":82740.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":100658.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107080.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38140.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":77614.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38140.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36715.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":99507.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38140.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83914.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35645.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37071.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39638.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47052.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38140.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70368.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37784.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35645.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":89873.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109186.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37428.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":101790.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":89873.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35645.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38140.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures With Cc","code_information":[{"code":"857","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17432.14,"maximum":89448.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31704.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56616.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18652.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53785.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37270.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56488.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37313.5},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39814.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17955.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17955.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34330.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64024.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89448.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38953.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":47389.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50413.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18652.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36540.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18652.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17955.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46847.45},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18652.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39506.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17432.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18129.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19384.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23010.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18652.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34412.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18478.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17432.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42311.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51404.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18303.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47922.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42311.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17432.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18652.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative Or Post-Traumatic Infections With O.R. Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11768.01,"maximum":58180.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20621.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36825.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12591.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34984.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24242.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36741.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24269.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25896.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12121.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12121.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22329.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41643.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58180.04},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25336.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30823.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32790.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12591.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23767.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12591.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12121.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30471.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12591.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25696.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11768.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12238.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13086.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15533.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12591.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23231.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12474.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11768.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27520.92},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33435.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12356.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31170.32},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27520.92},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11768.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12591.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":35071.83,"10th_percentile":35071.83,"90th_percentile":35071.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections With Mcc","code_information":[{"code":"862","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15027.57,"maximum":76174.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26999.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48214.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45804.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31739.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48105.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31776.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33906.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15478.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15478.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29235.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54523.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76174.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33173.1},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40356.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42931.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31117.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15478.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39895.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33643.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15027.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15628.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16710.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19836.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29665.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15929.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15027.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36032.66},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43776.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15778.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40810.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36032.66},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15027.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16079.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":42754.03,"10th_percentile":42754.03,"90th_percentile":42754.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16591.04,"10th_percentile":16591.04,"90th_percentile":16595.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without Mcc","code_information":[{"code":"863","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8779.33,"maximum":41681.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14773.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26382.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9393.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25063.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17367.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26322.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17387.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18552.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9042.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9042.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15997.33},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29834.22},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41681.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18151.8},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22082.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23491.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9393.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17027.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9393.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9042.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21830.06},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9393.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18409.26},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8779.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9130.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9762.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11588.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9393.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17331.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9306.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8779.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19716.51},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23953.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9218.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22331.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19716.51},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8779.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9393.88,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11513.84,"10th_percentile":11513.84,"90th_percentile":11513.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7945.53,"maximum":37078.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13142.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23469.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8501.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22295.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15449.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23415.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15467.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16504.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8183.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8183.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14230.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26539.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37078.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16147.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19643.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20897.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8501.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15146.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8501.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8183.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19419.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8501.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16376.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7945.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8263.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8835.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10488.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8501.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15685.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8422.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7945.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17539.18},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21308.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8342.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19864.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17539.18},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7945.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8501.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12565.5,"maximum":62582.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22182.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39612.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13445.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37631.3},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26076.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39522.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26106.38},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27856.39},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12942.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12942.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24019.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44794.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62582.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27254.08},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33155.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35271.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13445.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25565.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13445.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12942.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32776.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13445.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27640.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12565.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13068.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13972.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16586.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13445.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24805.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13319.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12565.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29603.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35965.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13193.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33528.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29603.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12565.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13445.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness Without Mcc","code_information":[{"code":"866","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7808.58,"maximum":36322.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12874.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22990.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8355.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21840.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15134.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22938.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15151.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16167.6},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8042.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8042.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13940.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25998.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36322.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15818.02},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19243.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20471.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8355.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14837.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8355.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8042.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19023.37},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8355.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16042.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7808.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8120.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8683.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10307.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8355.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15414.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8277.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7808.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17181.56},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20873.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8199.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19459.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17181.56},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7808.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8355.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8640.56,"10th_percentile":8640.56,"90th_percentile":8640.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":20873.88,"10th_percentile":20873.88,"90th_percentile":20873.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Mcc","code_information":[{"code":"867","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17066.69,"maximum":87430.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30989.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55340.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18261.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52572.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36430.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55214.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36471.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38916.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17578.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17578.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33556.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62580.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":87430.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38075.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46320.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49276.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18261.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35716.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18261.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17578.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45790.84},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18261.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38615.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17066.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17749.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18978.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22528.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18261.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33691.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18090.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17066.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41357.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50245.17},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17920.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46841.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41357.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17066.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18261.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With Cc","code_information":[{"code":"868","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9030.53,"maximum":43068.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15265.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27260.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25897.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17945.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27198.36},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17965.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19170.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9301.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9301.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16529.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30826.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43068.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18755.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22817.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24273.13},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17593.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9301.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22556.34},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19021.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9030.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9391.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10041.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11920.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9662.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17827.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9572.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9030.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20372.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24750.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9482.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23073.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20372.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9030.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9662.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6750.05,"maximum":30478.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10803.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19291.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7222.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18327.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12699.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19248.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12714.29},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13566.58},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11697.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21815.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30478.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13273.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16147.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17177.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7222.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12450.87},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7222.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15962.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7222.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13461.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6750.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7506.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8910.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7222.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13325.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7155.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6750.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14417.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17515.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7087.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16329.23},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14417.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6750.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7222.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 Hours","code_information":[{"code":"870","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":53525.61,"maximum":288698.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":102329.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":182734.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":173596.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":120292.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":182319.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":120431.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":128504.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55131.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":55131.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":110803.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":206642.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":288698.97},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":125725.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":152951.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162710.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":117936.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55131.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":151202.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127508.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53525.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55666.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59520.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":70653.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57272.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":105664.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56737.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53525.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":136563.34},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":165910.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56201.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":154672.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":136563.34},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53525.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57272.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15926.45,"maximum":81136.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28758.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51355.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48787.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33807.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51239.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33846.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36114.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16404.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16404.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31140.22},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58074.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81136.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35334.08},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42985.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45728.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33144.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16404.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42494.13},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35835.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15926.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16563.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17710.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21022.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17041.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31440.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16882.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15926.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38379.92},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46627.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16722.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43469.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38379.92},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15926.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17041.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":16763.13,"10th_percentile":16763.13,"90th_percentile":16763.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":44953.13,"10th_percentile":44953.13,"90th_percentile":44953.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14460.25,"10th_percentile":14460.25,"90th_percentile":14460.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15680.31,"10th_percentile":15680.31,"90th_percentile":15680.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"20","median_amount":17588.39,"10th_percentile":8116.05,"90th_percentile":20882.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5794.91,"10th_percentile":5794.91,"90th_percentile":5794.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3644.93,"10th_percentile":3644.93,"90th_percentile":3644.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":14602.49,"10th_percentile":12073.57,"90th_percentile":14783.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without Mcc","code_information":[{"code":"872","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8971.51,"maximum":42742.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15149.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27054.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25701.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17809.51},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26992.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17829.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19025.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16404.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30593.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42742.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18613.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22644.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24089.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17460.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9240.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22385.71},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18877.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8971.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9330.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9976.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11842.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17710.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9509.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8971.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20218.36},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24563.29},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9420.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22899.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20218.36},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8971.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9599.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5684.53,"10th_percentile":5684.53,"90th_percentile":5684.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10567.32,"10th_percentile":9910.42,"90th_percentile":11765.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5794.91,"10th_percentile":5794.91,"90th_percentile":5794.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":24563.29,"10th_percentile":24563.29,"90th_percentile":24563.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7487.43,"10th_percentile":7487.43,"90th_percentile":7487.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30471.88,"maximum":161433.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57219.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102180.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32604.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":97070.83},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":67264.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101948.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":67342.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":71856.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31386.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31386.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":61958.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":115548.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":161433.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":70302.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":85526.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90983.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32604.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":65946.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32604.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31386.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":84548.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32604.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71299.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31690.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33884.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":40222.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32604.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60154.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32300.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":76362.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92773.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31995.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":86488.73},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":76362.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30471.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32604.91,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial Dysfunction","code_information":[{"code":"880","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8494.08,"maximum":40106.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14215.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25385.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24116.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16711.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25328.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16730.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17852.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15392.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28707.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40106.59},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17466.04},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21248.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22604.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16383.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8748.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21005.34},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17713.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8494.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8833.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9445.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11212.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9088.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16768.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9003.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8494.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18971.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23048.64},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8918.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21487.36},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18971.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8494.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9088.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8348.05,"maximum":39300.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13930.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24875.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8932.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23631.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16375.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24819.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16394.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17493.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8598.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8598.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15083.57},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28130.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39300.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17114.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20821.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22149.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8932.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16054.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8932.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8598.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20583.13},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8932.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17357.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8348.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8681.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9283.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11019.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8932.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16479.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8848.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8348.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18590.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22585.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8765.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21055.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18590.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8348.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8932.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except Depressive","code_information":[{"code":"882","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9353.61,"maximum":44851.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15897.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28389.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26969.56},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18688.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28324.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18709.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19964.09},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9634.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9634.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17214.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32103.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44851.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19532.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23762.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25278.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18322.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9634.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23490.45},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19809.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9353.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9727.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10401.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12346.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10008.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18464.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9914.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9353.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21216.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25775.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9821.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24029.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21216.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9353.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10008.36,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18514.55,"10th_percentile":18514.55,"90th_percentile":18514.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse Control","code_information":[{"code":"883","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16106.53,"maximum":82130.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29111.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51985.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17233.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":49385.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34221.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51867.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34260.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36557.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16589.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16589.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31521.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58786.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82130.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35767.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":43512.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46288.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17233.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33550.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17233.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16589.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43014.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17233.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36274.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16106.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16750.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17910.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21260.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17233.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31795.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17072.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16106.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38850.16},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47199.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16911.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44001.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38850.16},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16106.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17233.99,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual Disability","code_information":[{"code":"884","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13402.33,"maximum":67202.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23819.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42536.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14340.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40409.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28001.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42439.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28033.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29912.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13804.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13804.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25792.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48101.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67202.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29265.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35603.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37875.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14340.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27452.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14340.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13804.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35196.3},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14340.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29680.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13402.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13938.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14903.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17691.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14340.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26457.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14206.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13402.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31788.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38620.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14072.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36003.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31788.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13402.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14340.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14808.06,"10th_percentile":14808.06,"90th_percentile":14808.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Psychoses","code_information":[{"code":"885","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11797.52,"maximum":58342.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20679.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36928.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12623.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35082.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24309.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36844.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24337.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25969.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12151.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12151.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22392.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41760.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58342.94},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25407.79},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30909.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32882.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12623.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23833.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12623.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12151.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30556.4},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12623.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25768.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11797.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12269.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13118.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15572.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12623.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23289.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12505.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11797.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27597.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33528.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12387.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31257.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27597.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11797.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12623.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":5908.0,"10th_percentile":5908.0,"90th_percentile":5908.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":4200.0,"10th_percentile":4200.0,"90th_percentile":4200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":3426.06,"10th_percentile":3426.06,"90th_percentile":4453.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"1 through 10","median_amount":3612.0,"10th_percentile":3612.0,"90th_percentile":3612.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":5620.0,"10th_percentile":5620.0,"90th_percentile":5620.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6136.18,"10th_percentile":3747.2,"90th_percentile":13024.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7812.4,"10th_percentile":7812.4,"90th_percentile":7812.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":3033.0,"10th_percentile":3033.0,"90th_percentile":3033.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3441.0,"10th_percentile":3441.0,"90th_percentile":3441.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"1 through 10","median_amount":4192.0,"10th_percentile":4192.0,"90th_percentile":4192.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12173.29,"10th_percentile":12173.29,"90th_percentile":12173.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With Mcc","code_information":[{"code":"196","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15508.03,"maximum":78826.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27940.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49893.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16593.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47398.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":32844.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":49780.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":32882.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35086.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15973.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15973.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30253.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":56421.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":78826.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34328.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":41761.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44426.58},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16593.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32201.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16593.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15973.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":41284.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16593.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34815.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15508.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16128.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17244.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20470.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16593.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30614.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16438.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15508.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37287.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45300.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16283.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42231.76},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37287.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15508.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16593.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17121.1,"10th_percentile":17121.1,"90th_percentile":17121.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without Cc/Mcc","code_information":[{"code":"195","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5984.34,"maximum":26251.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9304.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16616.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6403.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15785.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10938.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16578.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10950.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11685.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6163.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10075.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18790.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26251.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11432.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13908.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14795.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6403.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10724.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6403.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6163.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13749.07},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6403.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11594.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5984.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6223.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6654.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7899.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6403.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11813.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6343.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5984.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12417.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15086.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6283.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14064.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12417.9},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5984.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6403.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":16832.67,"10th_percentile":16832.67,"90th_percentile":16832.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":6068.97,"10th_percentile":6068.97,"90th_percentile":6068.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Simple Pneumonia And Pleurisy With Cc","code_information":[{"code":"194","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7326.6,"maximum":33661.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11931.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21306.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20240.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14025.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21258.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14042.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14983.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12919.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24093.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33661.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14659.32},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17833.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18971.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13751.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7546.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17629.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14867.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7326.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7619.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8147.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9671.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7839.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14463.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7766.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7326.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15922.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19344.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7692.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18034.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15922.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7326.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7839.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":17651.13,"10th_percentile":17651.13,"90th_percentile":17651.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7859.64,"10th_percentile":7859.64,"90th_percentile":7859.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7132.39,"10th_percentile":7132.39,"90th_percentile":7132.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9609.05,"10th_percentile":9609.05,"90th_percentile":9609.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5907.18,"10th_percentile":5907.18,"90th_percentile":5907.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11174.06,"maximum":54901.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19459.69},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34750.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11956.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33012.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22875.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34671.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22902.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24437.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11509.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11509.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21071.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39296.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54901.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23908.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29086.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30942.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11956.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22427.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11956.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11509.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28753.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11956.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24248.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11174.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11621.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12425.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14749.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11956.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22058.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11844.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11174.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25969.92},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31550.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11732.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29413.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25969.92},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11174.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11956.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":11749.38,"10th_percentile":11749.38,"90th_percentile":11749.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12338.66,"10th_percentile":12338.66,"90th_percentile":12341.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3955.84,"10th_percentile":3955.84,"90th_percentile":3955.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11765.06,"10th_percentile":11765.06,"90th_percentile":11765.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease Without Cc/Mcc","code_information":[{"code":"192","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6086.49,"maximum":26815.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9504.81},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16973.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6512.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16124.47},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11173.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16934.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11186.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11936.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6269.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6269.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10291.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19193.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26815.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11677.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14206.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15113.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6512.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10954.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6512.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6269.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14044.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6512.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11843.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6086.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6329.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6768.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8034.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6512.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12015.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6451.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6086.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12684.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15410.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6390.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14366.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12684.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6086.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6512.54,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":4291.9,"10th_percentile":4291.9,"90th_percentile":4291.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Cc","code_information":[{"code":"191","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7607.31,"maximum":35211.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12480.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22287.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8139.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21172.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14671.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22236.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14688.43},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15673.06},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7835.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7835.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13514.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25203.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35211.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15334.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18654.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19845.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8139.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14384.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8139.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7835.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18441.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8139.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15551.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7607.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7911.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8459.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10041.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8139.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15017.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8063.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7607.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16655.99},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20235.37},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7987.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18864.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16655.99},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7607.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8139.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8403.45,"10th_percentile":8041.48,"90th_percentile":9967.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7414.68,"10th_percentile":7414.68,"90th_percentile":7414.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With Mcc","code_information":[{"code":"190","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9610.11,"maximum":46267.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16399.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29285.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10282.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27820.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19278.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29218.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19300.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20594.36},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9898.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9898.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17757.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33116.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46267.52},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20149.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24512.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26076.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10282.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18900.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10282.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9898.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24232.05},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10282.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20434.85},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9610.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9994.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10686.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12685.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10282.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18971.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10186.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9610.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21885.94},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26589.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10090.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24788.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21885.94},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9610.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10282.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2563.56,"10th_percentile":2563.56,"90th_percentile":2563.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6962.99,"10th_percentile":6962.99,"90th_percentile":10609.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2613.33,"10th_percentile":2613.33,"90th_percentile":2613.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9129.1,"10th_percentile":9129.1,"90th_percentile":9129.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory Failure","code_information":[{"code":"189","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10576.32,"maximum":51601.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18290.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32661.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11316.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31028.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21500.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32587.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21525.61},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22968.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10893.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10893.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19804.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36934.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51601.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22471.93},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":27338.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29082.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11316.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21079.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11316.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10893.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27025.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11316.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22790.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10576.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10999.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11760.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13960.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11316.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20878.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11210.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10576.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24409.03},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29654.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11105.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27645.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24409.03},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10576.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11316.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11680.35,"10th_percentile":11675.6,"90th_percentile":13168.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10912.79,"10th_percentile":10912.79,"90th_percentile":10912.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without Cc/Mcc","code_information":[{"code":"188","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6655.47,"maximum":29956.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10618.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18961.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18013.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12482.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18918.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12496.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13334.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6855.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6855.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11497.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21442.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29956.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13045.87},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15870.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16883.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12237.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6855.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15689.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13230.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6655.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6921.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7400.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8785.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13138.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7054.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6655.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14170.44},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17215.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6988.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16049.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14170.44},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6655.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7121.35,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Cc","code_information":[{"code":"187","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8712.75,"maximum":41313.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14643.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26149.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9322.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24842.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17214.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26090.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17234.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18389.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8974.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8974.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15856.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29571.12},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41313.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17991.73},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21887.79},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23284.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9322.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16877.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9322.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8974.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21637.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9322.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18246.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8712.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9061.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9688.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11500.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9322.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17199.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9235.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8712.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19542.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23742.36},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9148.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22134.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19542.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8712.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9322.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion With Mcc","code_information":[{"code":"186","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13020.99,"maximum":65096.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23073.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41203.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13932.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39143.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27124.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41110.11},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27155.3},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28975.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13411.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13411.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24984.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46594.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65096.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28349.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34488.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36688.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13932.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26592.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13932.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13411.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34093.75},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13932.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28751.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13020.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13541.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14479.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17187.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13932.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25704.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13802.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13020.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30792.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37410.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13672.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34876.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30792.84},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13020.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13932.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17080.99,"10th_percentile":17080.99,"90th_percentile":17080.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7179.82,"maximum":32851.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11644.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20793.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7682.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19753.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13688.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20746.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13703.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14622.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7395.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7395.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12608.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23513.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32851.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14306.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17404.46},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18515.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7682.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13420.05},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7682.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7395.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17205.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7682.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14509.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7179.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7467.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7983.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9477.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7682.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14173.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7610.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7179.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15539.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18879.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7538.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17600.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15539.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7179.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7682.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9280.22,"maximum":44446.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15754.0},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28132.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26725.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18519.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28068.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18540.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19783.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9558.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9558.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17058.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":31813.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44446.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19355.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23547.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25049.98},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18156.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9558.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23278.25},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19630.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9651.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10319.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12249.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18320.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9837.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21024.49},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25542.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9744.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23812.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21024.49},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9280.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9929.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Mcc","code_information":[{"code":"183","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12804.6,"maximum":63902.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22650.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40447.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13700.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38424.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26626.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40355.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26656.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28443.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13188.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13188.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24525.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45739.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63902.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27828.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33855.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36015.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13700.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26104.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13700.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13188.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33468.09},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13700.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28223.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12804.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13316.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14238.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16902.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13700.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25277.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13572.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12804.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30227.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36723.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13444.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34236.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30227.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12804.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13700.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":13480.93,"10th_percentile":13480.93,"90th_percentile":13480.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11443.85,"10th_percentile":11443.85,"90th_percentile":11443.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms Without Cc/Mcc","code_information":[{"code":"182","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6932.4,"maximum":31485.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11160.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19928.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7417.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18932.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13119.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19883.74},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13134.21},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14014.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7140.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7140.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12084.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22536.36},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31485.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13711.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16680.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17745.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7417.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12862.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7417.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7140.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16490.13},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7417.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13906.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6932.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7209.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7708.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9150.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7417.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13685.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7348.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6932.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14893.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18094.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7279.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16868.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14893.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6932.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7417.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Cc","code_information":[{"code":"181","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9332.43,"maximum":44734.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15856.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28315.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9985.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26899.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18639.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28250.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18661.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19912.03},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9612.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9612.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17169.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32019.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44734.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19481.49},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23700.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25212.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9985.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18274.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9985.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9612.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23429.2},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9985.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19757.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9705.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10377.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12318.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9985.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18423.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9892.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21160.82},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25708.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9799.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23966.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21160.82},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9332.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9985.7,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With Mcc","code_information":[{"code":"180","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14591.0,"maximum":73764.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26145.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46689.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15612.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44354.86},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30735.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46583.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30770.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32833.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15028.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15028.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28310.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52798.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73764.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32123.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39079.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41573.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15612.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30133.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15612.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15028.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38633.02},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15612.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32579.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14591.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15174.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16225.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19260.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15612.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28804.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15466.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14591.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34892.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42391.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15320.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39519.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34892.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14591.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15612.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15656.58,"10th_percentile":15656.58,"90th_percentile":15656.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without Cc/Mcc","code_information":[{"code":"179","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6941.48,"maximum":31535.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11177.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19960.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7427.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18962.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13140.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19915.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13155.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14036.96},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7149.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7149.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12103.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22572.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31535.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13733.45},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16707.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17773.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7427.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12882.57},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7427.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7149.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16516.38},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7427.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13928.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6941.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7219.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7718.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9162.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7427.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13703.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7357.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6941.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14917.29},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18123.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7288.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16895.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14917.29},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6941.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7427.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":18123.02,"10th_percentile":18123.02,"90th_percentile":18123.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Cc","code_information":[{"code":"178","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8613.63,"maximum":40766.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14449.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25803.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9216.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24513.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16986.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25744.93},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17005.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18145.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8872.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8872.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15646.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29179.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40766.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17753.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21597.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22976.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9216.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16653.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9216.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8872.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21350.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9216.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18005.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8613.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8958.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9578.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11369.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9216.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17004.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9130.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8613.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19283.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23427.9},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9044.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21840.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19283.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8613.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9216.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1000.0,"10th_percentile":1000.0,"90th_percentile":1000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8971.57,"10th_percentile":8971.57,"90th_percentile":8971.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With Mcc","code_information":[{"code":"177","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13052.77,"maximum":65272.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23135.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41314.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13966.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39248.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27197.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41220.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27228.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29053.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13444.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13444.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25051.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46720.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65272.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28425.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34580.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36787.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13966.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26664.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13966.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13444.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34185.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13966.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28828.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13052.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13574.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14514.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17229.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13966.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25767.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13835.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13052.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30875.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37511.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13705.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34970.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30875.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13052.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13966.46,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17105.15,"10th_percentile":17105.15,"90th_percentile":17105.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":7827.92,"10th_percentile":7827.92,"90th_percentile":7827.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without Mcc","code_information":[{"code":"176","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7319.79,"maximum":33624.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11918.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21282.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7832.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20218.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14010.22},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21234.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14026.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14966.56},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7539.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7539.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12904.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24067.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33624.05},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14642.95},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17813.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18950.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7832.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13735.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7832.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7539.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17610.18},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7832.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14850.64},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7612.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8139.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9662.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7832.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14450.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7758.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15905.19},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19323.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7685.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18014.29},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15905.19},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7832.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4808.59,"10th_percentile":4808.59,"90th_percentile":4808.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11621.99,"maximum":57373.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20336.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36315.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34499.34},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23906.13},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36232.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23933.61},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25537.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11970.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11970.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22020.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41066.52},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57373.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24985.78},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30396.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32335.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23437.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11970.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30048.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25340.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11621.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12086.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12923.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15341.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12435.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22942.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12319.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11621.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27139.59},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32971.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12203.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30738.42},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27139.59},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11621.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12435.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12842.01,"10th_percentile":12842.01,"90th_percentile":12842.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23749.23,"maximum":124321.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44065.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78690.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25411.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":74755.26},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":51801.27},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":78511.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51860.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":55337.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24461.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24461.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":47714.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":88985.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":124321.25},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":54140.72},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":65864.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70067.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25411.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":50786.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25411.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24461.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":65111.73},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25411.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54908.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23749.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24699.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26409.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31348.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25411.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46883.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25174.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23749.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58807.71},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71445.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24936.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":66605.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":58807.71},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23749.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25411.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"168","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11567.51,"maximum":57073.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20229.55},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36124.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34318.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23780.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36042.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23808.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25404.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11914.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11914.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21904.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40851.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":57073.16},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24854.82},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30237.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32166.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23314.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11914.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29891.37},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25207.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11567.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12030.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12863.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15269.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12377.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22835.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12261.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11567.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26997.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32799.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12145.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30577.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26997.33},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11567.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12377.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14873.98,"maximum":75326.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26699.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47678.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15915.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45294.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31386.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47570.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31422.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33528.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15320.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15320.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28910.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":53916.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75326.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32803.85},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":39907.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42453.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15915.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30771.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15915.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15320.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39451.18},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15915.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33269.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14873.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15468.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16539.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19633.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15915.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29362.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15766.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14873.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35631.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43288.81},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15617.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40356.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35631.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14873.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15915.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29509.45,"maximum":156119.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55336.65},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98817.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31575.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":93876.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":65050.93},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":98593.05},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":65125.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":69491.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30394.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30394.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":59919.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":111746.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":156119.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":67988.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":82711.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87989.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31575.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":63776.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31575.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30394.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":81765.93},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31575.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68953.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29509.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30689.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32814.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38952.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31575.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58254.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31280.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29509.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":73849.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89719.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30984.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":83642.25},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":73849.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29509.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31575.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30883.76,"10th_percentile":30883.76,"90th_percentile":30883.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15712.32,"maximum":79954.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28339.73},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50607.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16812.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48077.05},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33314.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50492.77},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33353.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35588.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16183.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16183.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30686.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57228.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79954.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34819.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42359.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45062.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16812.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32661.99},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16812.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16183.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":41875.04},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16812.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35313.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15712.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16340.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17472.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20740.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16812.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31017.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16655.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15712.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37820.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45948.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16497.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42835.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37820.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15712.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16812.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20326.25,"maximum":105424.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37367.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66729.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21749.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":63392.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43927.7},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66578.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":43978.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46926.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20936.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20936.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40462.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75460.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":105424.96},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45911.56},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":55853.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59417.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21749.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43067.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21749.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20936.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":55215.02},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21749.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46562.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20326.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21139.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22602.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26830.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21749.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40126.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21545.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20326.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49869.19},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60586.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21342.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56482.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":49869.19},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20326.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21749.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22452.28,"10th_percentile":22452.28,"90th_percentile":22452.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Mcc","code_information":[{"code":"163","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35139.53,"maximum":187200.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":66353.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118489.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":112564.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":78001.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":118220.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":78090.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":83325.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36193.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36193.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":71847.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":133992.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":187200.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":81523.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":99177.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105506.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":76472.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36193.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":98043.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82680.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35139.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36545.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39075.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46384.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37599.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69368.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37247.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35139.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":88551.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107581.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36896.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":100293.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":88551.4},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35139.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37599.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without Cc/Mcc","code_information":[{"code":"159","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6589.65,"maximum":29593.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10489.34},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18731.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7050.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17794.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12330.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18688.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12344.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13172.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6787.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6787.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11357.96},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21182.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":29593.34},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12887.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15678.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16678.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7050.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12089.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7050.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6787.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15499.15},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7050.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13070.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6589.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6853.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7327.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8698.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7050.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13008.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6985.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6589.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13998.54},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17006.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6919.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15854.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13998.54},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6589.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7050.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Cc","code_information":[{"code":"158","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8112.74,"maximum":38001.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13469.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24053.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8680.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22850.54},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15834.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23998.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15852.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16915.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8356.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8356.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14585.0},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27200.29},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38001.44},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16549.26},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20132.96},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21417.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8680.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15523.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8680.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8356.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19902.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8680.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16783.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8112.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8437.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9021.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10708.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8680.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16015.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8599.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8112.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17975.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21838.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8518.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20359.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17975.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8112.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8680.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases With Mcc","code_information":[{"code":"157","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14218.74,"maximum":71709.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25417.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45388.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43119.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29879.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45285.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29913.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31918.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14645.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14645.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27522.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51327.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71709.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31228.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37991.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40415.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29293.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14645.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37556.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31671.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14787.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15811.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18768.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15214.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28069.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15071.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33920.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41210.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14929.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38418.55},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33920.53},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14218.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15214.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without Cc/Mcc","code_information":[{"code":"156","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6457.99,"maximum":28866.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10231.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18271.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6910.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17357.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12027.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18229.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12041.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12848.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11079.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20661.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28866.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12571.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15293.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16269.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6910.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11792.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6910.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6651.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15118.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6910.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12749.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6457.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6716.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7181.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8524.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6910.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12748.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6845.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6457.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13654.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16589.16},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6780.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15465.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13654.75},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6457.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6910.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6382.98,"10th_percentile":6382.98,"90th_percentile":6382.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Cc","code_information":[{"code":"155","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8163.43,"maximum":38281.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13568.78},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24230.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23018.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15950.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24175.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15969.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17039.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8408.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8408.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14692.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27400.6},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38281.29},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16671.14},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20281.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21575.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15638.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8408.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20049.35},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16907.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8163.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8489.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9077.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10775.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8734.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16115.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8653.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8163.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18108.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21999.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8571.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20509.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18108.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8163.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8734.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With Mcc","code_information":[{"code":"154","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13058.82,"maximum":65305.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23147.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41335.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13972.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39268.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27211.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41242.0},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27242.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29068.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13450.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13450.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25064.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46743.96},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65305.83},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28440.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34598.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36806.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13972.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26678.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13972.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13450.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34203.13},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13972.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28843.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13058.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13581.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14521.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17237.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13972.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25779.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13842.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13058.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30891.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37530.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13711.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34988.0},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30891.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13058.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13972.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without Mcc","code_information":[{"code":"153","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6814.37,"maximum":30833.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10929.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19516.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18540.63},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12847.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19472.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12862.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13724.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7018.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7018.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11834.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22069.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30833.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13427.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16335.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17377.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12595.91},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7018.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16148.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13618.31},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6814.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7086.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8994.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7291.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13452.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7223.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6814.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14585.36},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17719.75},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7155.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16519.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14585.36},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6814.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7291.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13486.34,"10th_percentile":13486.34,"90th_percentile":13486.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental Disorders","code_information":[{"code":"886","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16931.25,"maximum":86683.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30724.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54866.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18116.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":52123.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36118.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54742.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36160.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38583.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33269.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":62045.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86683.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37749.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":45924.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48854.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18116.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35410.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18116.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17439.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45399.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18116.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38285.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16931.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17608.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18827.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22349.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18116.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33423.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17947.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16931.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41003.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49815.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17777.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46441.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41003.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16931.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18116.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Mental Disorder Diagnoses","code_information":[{"code":"887","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9331.67,"maximum":44730.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15854.67},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28312.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":26896.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18637.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28248.2},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18659.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19910.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9611.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9611.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17167.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32016.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":44730.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19479.67},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":23697.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25210.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18272.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9611.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23427.01},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19755.96},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9331.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9704.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10376.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12317.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9984.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18421.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9891.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9331.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21158.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25705.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9798.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23964.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21158.84},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9331.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9984.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence, Left Ama","code_information":[{"code":"894","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5896.57,"maximum":25767.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9133.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16309.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6309.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15494.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10736.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16272.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10748.87},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11469.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6073.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6073.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":9889.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18443.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":25767.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11221.41},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13651.38},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14522.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6309.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10526.16},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6309.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6073.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13495.3},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6309.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11380.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6132.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6556.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7783.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6309.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11640.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6250.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12188.71},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14808.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6191.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":13804.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12188.71},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5896.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6309.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation Therapy","code_information":[{"code":"895","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11939.77,"maximum":59128.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20957.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37425.63},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12775.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35554.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24637.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37340.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24665.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26318.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12297.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12297.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22693.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":42322.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":59128.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25749.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31325.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33324.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12775.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":24154.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12775.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12297.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30967.67},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12775.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26114.99},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13277.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15760.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12775.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23570.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12656.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27969.42},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33980.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12536.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31678.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27969.42},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11939.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12775.55,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With Mcc","code_information":[{"code":"896","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14432.86,"maximum":72891.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25836.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46136.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15443.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43829.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30371.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46032.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30406.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32444.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14865.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14865.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27975.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52173.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72891.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31743.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38617.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41081.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15443.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29776.64},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15443.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14865.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38175.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15443.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32193.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14432.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15010.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16049.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19051.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15443.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28491.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15298.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14432.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34479.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41889.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15154.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39051.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34479.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14432.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15443.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28572.51,"10th_percentile":28572.51,"90th_percentile":28572.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without Mcc","code_information":[{"code":"897","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7908.45,"maximum":36873.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13069.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23339.47},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8462.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22172.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15364.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23286.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15381.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16413.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8145.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8145.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14152.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26393.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36873.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16058.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19535.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20781.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8462.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15063.22},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8462.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8145.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19312.13},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8462.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16285.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7908.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8224.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8794.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10439.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8462.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15612.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8382.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7908.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17442.36},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21190.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8303.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19755.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17442.36},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7908.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8462.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":4453.8,"10th_percentile":4453.8,"90th_percentile":4453.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6034.31,"10th_percentile":4235.24,"90th_percentile":10365.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4404.1,"10th_percentile":4404.1,"90th_percentile":4404.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Mcc","code_information":[{"code":"901","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32981.62,"maximum":175287.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62130.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110949.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35290.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":105401.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":73037.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":110697.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":73121.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":78023.19},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33971.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33971.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67275.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":125465.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":175287.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":76336.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":92866.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98792.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35290.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71606.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35290.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33971.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":91804.82},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35290.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77418.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32981.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34300.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36675.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43535.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35290.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65109.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34960.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32981.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":82916.42},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100735.19},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34630.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":93911.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":82916.42},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32981.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35290.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With Cc","code_information":[{"code":"902","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15714.59,"maximum":79966.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28344.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50615.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16814.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48084.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33319.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50500.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33358.25},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35594.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16186.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16186.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30691.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57237.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79966.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34824.76},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42365.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45069.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16814.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32667.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16814.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16186.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":41881.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16814.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35318.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15714.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16343.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17474.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20743.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16814.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31022.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16657.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15714.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37826.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45955.66},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16500.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42842.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37826.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15714.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16814.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without Cc/Mcc","code_information":[{"code":"903","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10078.46,"maximum":48853.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17315.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30921.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10783.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29375.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20355.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30851.71},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20379.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21745.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10380.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10380.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18749.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34967.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48853.02},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21275.02},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25882.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27533.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10783.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19956.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10783.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10380.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25586.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10783.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21576.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10481.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11207.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13303.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10783.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19895.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10683.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23108.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28075.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10582.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26173.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23108.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10078.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10783.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With Cc/Mcc","code_information":[{"code":"904","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29020.67,"maximum":153421.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54380.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97109.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31052.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":92253.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":63926.63},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":96889.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":64000.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":68290.28},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29891.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29891.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":58883.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":109814.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":153421.71},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66813.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":81282.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86468.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31052.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":62674.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31052.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29891.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":80352.74},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31052.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67761.35},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29020.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30181.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32270.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":38307.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31052.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57289.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30761.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29020.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":72573.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88169.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30471.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":82196.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":72573.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29020.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31052.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without Cc/Mcc","code_information":[{"code":"905","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12452.76,"maximum":61960.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21961.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39218.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13324.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37257.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25817.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39129.13},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25846.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27579.37},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23780.39},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44349.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":61960.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":26983.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32826.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34920.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13324.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25311.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13324.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12826.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32450.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13324.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27365.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12452.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12950.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13847.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16437.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13324.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24582.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13199.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12452.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29309.02},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35607.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13075.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33195.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29309.02},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12452.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13324.45,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hand Procedures For Injuries","code_information":[{"code":"906","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16091.39,"maximum":82046.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29081.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51932.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":49335.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34186.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51814.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34225.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36520.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16574.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16574.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31489.69},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58726.68},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":82046.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35730.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":43467.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46241.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33516.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16574.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42971.03},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36237.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16091.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16735.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17893.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21240.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17217.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31766.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17056.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16091.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38810.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47151.06},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16895.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43957.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38810.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16091.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17217.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Mcc","code_information":[{"code":"907","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30278.19,"maximum":160363.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":56840.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101503.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32397.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":96427.86},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":66819.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101273.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":66895.96},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":71380.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31186.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31186.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":61547.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":114783.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":160363.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":69836.87},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":84959.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90380.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32397.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":65509.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32397.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31186.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":83988.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32397.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70827.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30278.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31489.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33669.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39967.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32397.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59772.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32094.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30278.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":75856.89},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92158.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31792.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":85915.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":75856.89},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30278.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32397.66,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":39714.34,"10th_percentile":39714.34,"90th_percentile":39714.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":9943.94,"10th_percentile":9943.94,"90th_percentile":9943.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16325.19,"maximum":83337.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29538.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52749.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17467.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50111.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34724.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":52629.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":34764.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37094.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16814.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16814.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31985.05},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":59650.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83337.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36292.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44151.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46969.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17467.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34044.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17467.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16814.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43647.0},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17467.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36807.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16325.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16978.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18153.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21549.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17467.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32227.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17304.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16325.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39421.16},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47892.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17141.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":44648.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39421.16},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16325.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17467.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11161.2,"maximum":54830.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19434.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34705.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11942.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32969.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22846.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34626.4},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22872.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24405.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11496.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11496.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21043.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39245.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54830.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23878.01},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29048.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30902.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11942.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22398.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11942.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11496.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28716.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11942.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24216.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11607.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12411.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14732.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11942.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22033.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11830.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25936.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31510.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11719.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29375.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25936.33},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11161.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11942.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13596.79,"maximum":68275.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24200.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43215.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14548.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41054.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28448.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43117.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28481.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30390.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14004.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14004.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26204.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48869.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68275.61},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29733.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36172.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38480.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14548.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27891.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14548.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14004.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35758.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14548.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30155.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13596.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14140.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15119.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17947.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14548.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26841.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14412.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13596.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32296.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39236.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14276.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36579.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32296.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13596.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14548.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without Mcc","code_information":[{"code":"914","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7928.88,"maximum":36986.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13109.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23410.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8483.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22240.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15411.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23357.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15428.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16463.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8166.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8166.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14195.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26473.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":36986.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16107.25},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19595.23},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20845.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8483.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15109.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8483.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8166.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19371.2},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8483.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16335.7},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7928.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8246.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8816.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8483.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15652.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8404.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7928.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17495.71},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21255.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8325.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19815.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17495.71},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7928.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8483.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10398.56,"10th_percentile":10398.56,"90th_percentile":10398.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With Mcc","code_information":[{"code":"915","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13952.4,"maximum":70238.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24896.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44458.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42235.07},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29266.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":44357.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29300.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31264.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14370.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14370.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26957.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":50274.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":70238.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30588.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37212.13},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39586.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28693.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14370.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36786.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31022.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13952.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14510.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15515.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18417.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14929.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27543.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14789.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13952.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33225.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40365.13},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14650.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37630.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33225.05},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13952.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14929.07,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":39586.55,"10th_percentile":39586.55,"90th_percentile":39586.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without Mcc","code_information":[{"code":"916","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6270.35,"maximum":27830.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9864.57},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17615.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6709.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16734.79},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11596.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17575.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11609.61},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12387.85},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6458.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6458.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10681.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19920.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27830.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12120.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14744.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15685.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6709.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11369.08},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6709.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6458.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14575.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6709.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12291.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6270.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6521.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6972.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8276.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6709.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12378.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6646.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6270.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13164.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15993.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6583.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14910.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13164.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6270.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6709.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs With Mcc","code_information":[{"code":"917","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13095.9,"maximum":65510.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23220.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41465.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14012.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":39391.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27296.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":41371.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27327.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29159.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13488.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13488.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25143.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46890.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":65510.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28529.2},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34707.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36921.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14012.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26761.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14012.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13488.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34310.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14012.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28933.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13095.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13619.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14562.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17286.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14012.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25852.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13881.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13095.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30988.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37647.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13750.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35097.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30988.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13095.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14012.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":13779.84,"10th_percentile":13779.84,"90th_percentile":13779.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14051.88,"10th_percentile":14051.88,"90th_percentile":14051.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14457.42,"10th_percentile":14457.42,"90th_percentile":14462.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":21640.97,"10th_percentile":21640.97,"90th_percentile":21640.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11195.94,"10th_percentile":11195.94,"90th_percentile":11195.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning And Toxic Effects Of Drugs Without Mcc","code_information":[{"code":"918","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7714.0,"maximum":35800.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12689.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22660.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21526.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14916.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22608.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14934.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15935.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7945.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7945.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13740.17},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25624.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":35800.21},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15590.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18966.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20176.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14624.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7945.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18749.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15811.78},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7714.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8022.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8577.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10182.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8253.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15228.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8176.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7714.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16934.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20573.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8099.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19180.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16934.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7714.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8253.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8275.43,"10th_percentile":8275.43,"90th_percentile":8275.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":12544.09,"10th_percentile":12544.09,"90th_percentile":12544.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Mcc","code_information":[{"code":"919","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15081.29,"maximum":76470.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":27104.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48402.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16136.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45982.37},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31863.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":48292.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31899.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":34038.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15533.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15533.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29349.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54735.43},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":76470.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":33302.25},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40513.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43098.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16136.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":31238.94},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16136.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15533.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":40050.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16136.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33774.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15081.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15684.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16770.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19907.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16136.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29771.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15986.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15081.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":36172.95},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43946.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15835.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40969.64},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":36172.95},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15081.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16136.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":31899.86,"10th_percentile":31899.86,"90th_percentile":31899.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8812.62,"maximum":41865.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14839.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26498.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9429.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25173.77},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17444.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26438.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17464.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18634.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9077.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9077.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16067.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29965.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41865.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18231.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22179.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23595.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9429.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17102.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9429.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9077.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21926.31},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9429.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18490.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8812.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9165.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9799.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11632.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9429.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17396.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9341.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8812.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19803.44},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24059.21},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9253.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22429.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19803.44},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8812.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9429.5,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment Without Cc/Mcc","code_information":[{"code":"921","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6437.56,"maximum":28753.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10191.76},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18199.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":17289.85},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":11980.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":18158.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11994.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12798.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6630.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6630.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11035.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":20581.09},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":28753.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":12522.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":15233.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16205.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":11746.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6630.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":15059.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12699.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6437.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6695.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7158.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8497.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6888.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12708.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6823.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6437.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13601.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16524.35},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6759.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":15405.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13601.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6437.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6888.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14465.4,"maximum":73070.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25899.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46250.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15477.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43937.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30446.56},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46145.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30481.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32524.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14899.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14899.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28044.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52301.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73070.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31821.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38712.47},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41182.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15477.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29850.01},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15477.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14899.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38269.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15477.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32272.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14465.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15044.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16085.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19094.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15477.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28556.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15333.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14465.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34564.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41992.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15188.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39148.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34564.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14465.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15477.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses Without Mcc","code_information":[{"code":"923","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8929.14,"maximum":42508.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15067.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26905.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9554.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25560.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17712.05},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26844.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17732.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18921.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9197.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9197.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16314.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30426.18},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42508.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18511.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22520.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23957.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9554.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17365.02},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9554.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9197.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22263.21},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9554.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18774.53},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8929.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9286.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9929.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11786.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9554.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17627.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9464.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8929.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20107.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24428.87},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9375.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22774.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20107.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8929.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9554.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin Graft","code_information":[{"code":"927","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":162773.0,"maximum":891789.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":316094.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":564464.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":536239.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":371584.1},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":563183.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":372011.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":396948.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167656.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":167656.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":342269.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":638315.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":891789.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":388365.6},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":472465.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":502612.12},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":364303.58},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167656.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":467063.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393874.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162773.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169283.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181003.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":214860.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174167.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":321330.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172539.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162773.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":421843.18},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":512497.4},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":170911.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":477781.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":421843.18},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162773.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":174167.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With Cc/Mcc","code_information":[{"code":"928","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55499.66,"maximum":299596.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":106191.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":189631.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59384.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":180149.53},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":124833.67},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":189201.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":124977.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":133354.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57164.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":57164.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":114985.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":214442.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":299596.51},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":130471.41},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":158724.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168852.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59384.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":122387.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59384.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57164.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":156909.99},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59384.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132321.97},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55499.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57719.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61715.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":73259.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59384.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":109561.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58829.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55499.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":141718.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172173.49},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58274.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":160510.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":141718.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55499.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59384.64,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without Cc/Mcc","code_information":[{"code":"929","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25598.44,"maximum":134529.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47683.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85151.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27390.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":80893.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":56054.8},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":84958.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":56119.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59881.11},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26366.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26366.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":51632.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":96292.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":134529.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":58586.35},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":71273.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75820.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27390.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":54956.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27390.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26366.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":70458.22},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27390.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59417.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25598.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26622.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28465.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33789.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27390.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50533.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27134.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25598.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":63636.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77312.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26878.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":72075.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":63636.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25598.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27390.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin Graft","code_information":[{"code":"933","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30693.58,"maximum":162656.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57653.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102954.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32842.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":97806.73},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":67774.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":102721.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":67852.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":72400.97},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31614.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31614.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":62427.92},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":116424.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":162656.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":70835.5},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":86174.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91673.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32842.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":66446.73},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32842.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31614.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":85189.52},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32842.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71840.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31921.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34131.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":40515.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32842.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60592.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32535.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":76941.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93476.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32228.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":87144.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":76941.6},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30693.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32842.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn Without Skin Graft Or Inhalation Injury","code_information":[{"code":"934","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17954.97,"maximum":92334.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32727.93},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58443.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19211.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":55521.43},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38473.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":58311.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38517.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41099.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18493.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18493.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35438.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":66090.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":92334.55},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":40210.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48918.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52039.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19211.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37719.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19211.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18493.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":48359.09},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19211.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40781.15},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18673.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19965.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23700.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19211.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35444.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19032.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43677.03},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53063.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18852.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49468.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43677.03},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17954.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19211.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive Burns","code_information":[{"code":"935","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16815.49,"maximum":86044.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30498.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54462.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17992.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":51738.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35852.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":54338.68},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35893.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":38299.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17319.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17319.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33023.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":61587.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":86044.14},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":37471.4},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":45585.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48494.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17992.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":35149.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17992.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17319.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":45064.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17992.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38002.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17488.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18698.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22196.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17992.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33195.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17824.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40701.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49448.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17656.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":46098.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40701.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16815.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17992.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Mcc","code_information":[{"code":"939","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28683.21,"maximum":151558.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53719.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95930.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30691.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":91133.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":63150.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":95712.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":63222.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":67461.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29543.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29543.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":58168.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":108481.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":151558.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":66002.42},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":80295.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85418.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30691.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":61913.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30691.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29543.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":79377.07},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30691.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66938.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28683.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29830.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31895.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37861.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30691.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56623.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30404.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28683.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71691.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87098.51},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30117.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":81198.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":71691.9},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28683.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30691.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services With Cc","code_information":[{"code":"940","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18910.59,"maximum":97609.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34597.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61782.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20234.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":58693.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40671.41},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61642.75},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40718.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43447.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19477.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19477.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37462.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69866.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97609.98},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42508.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":51713.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55012.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20234.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39874.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20234.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19477.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":51122.02},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20234.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43111.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18910.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19667.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21028.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24961.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20234.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37331.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20045.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18910.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46172.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56094.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19856.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":52295.15},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":46172.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18910.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20234.33,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Diagnoses Of Other Contact With Health Services Without Cc/Mcc","code_information":[{"code":"941","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16571.1,"maximum":84695.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":30020.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53608.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50927.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":35290.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53486.67},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35330.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37699.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32506.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60622.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":84695.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36883.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44870.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47734.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34598.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17068.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":44357.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37407.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16571.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17233.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18427.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21873.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17731.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32713.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17565.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16571.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":40063.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48672.91},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17399.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45375.87},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":40063.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16571.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17731.08,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12946.09,"maximum":64683.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22927.02},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40941.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13852.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38894.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26951.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40848.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26982.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28791.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13334.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13334.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24825.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46298.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64683.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":28169.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34268.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36455.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13852.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26423.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13852.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13334.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33877.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13852.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28568.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12946.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13463.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14396.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17088.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13852.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25556.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13722.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12946.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30597.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37172.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13593.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34654.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30597.24},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12946.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13852.32,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9905.95,"maximum":47900.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16978.37},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30319.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28803.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19958.91},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30250.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19981.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21321.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10203.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10203.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18384.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34285.88},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":47900.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20860.29},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25377.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26996.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19567.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10203.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25087.4},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21156.17},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10302.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11015.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13075.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10599.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19555.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10500.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22658.47},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27527.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10401.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25663.09},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22658.47},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9905.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10599.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10833.58,"maximum":53021.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18793.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33560.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11591.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31882.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22092.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33484.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22118.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23600.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11158.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11158.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20349.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37951.25},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53021.57},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23090.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28090.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29882.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11591.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21659.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11591.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11158.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27769.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11591.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23417.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10833.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11266.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12046.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14300.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11591.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21386.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11483.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10833.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25080.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30470.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11375.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28406.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25080.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10833.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11591.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4041.49,"10th_percentile":4041.49,"90th_percentile":4041.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":9527.01,"10th_percentile":9527.01,"90th_percentile":9527.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without Mcc","code_information":[{"code":"948","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7285.74,"maximum":33436.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11851.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21163.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7795.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20105.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13931.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21115.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13947.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14882.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7504.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7504.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12832.82},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23932.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33436.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14561.1},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17714.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18844.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7795.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13658.93},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7795.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7504.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17511.74},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7795.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14767.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7285.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8101.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9617.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7795.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14382.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7722.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7285.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15816.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19215.2},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7650.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17913.59},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15816.28},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7285.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7795.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8043.86,"10th_percentile":8043.86,"90th_percentile":8043.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6073.41,"10th_percentile":6073.41,"90th_percentile":6073.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri With Mcc","code_information":[{"code":"152","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10173.8,"maximum":49379.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17502.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31255.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10885.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29692.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20575.01},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31184.07},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20598.65},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21979.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10479.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10479.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18951.85},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35344.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49379.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21504.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26160.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27830.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10885.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20171.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10885.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10479.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25861.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10885.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21809.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10173.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10580.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11313.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13429.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10885.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20084.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10784.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10173.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23357.91},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28377.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10682.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26455.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23357.91},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10173.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10885.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis Without Mcc","code_information":[{"code":"151","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6782.59,"maximum":30658.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":10866.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19405.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7257.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18435.14},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":12774.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19361.45},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":12789.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13646.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6986.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6986.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":11766.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":21944.4},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":30658.45},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13351.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16242.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17279.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7257.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12524.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7257.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6986.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16056.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7257.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13540.83},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6782.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7053.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7542.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8953.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7257.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13389.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7189.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6782.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14502.37},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17618.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7121.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16425.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14502.37},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6782.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7257.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Epistaxis With Mcc","code_information":[{"code":"150","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11303.44,"maximum":55615.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19712.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35202.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12094.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33441.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23173.43},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35122.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23200.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24755.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11642.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11642.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21345.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39807.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55615.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24219.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29464.76},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31344.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12094.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22719.38},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12094.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11642.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29127.89},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12094.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24563.51},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11303.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11755.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12569.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14920.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12094.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22314.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11981.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11303.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26307.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31961.33},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11868.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29796.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26307.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11303.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12094.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dysequilibrium","code_information":[{"code":"149","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6915.75,"maximum":31393.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11127.44},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19870.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7399.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18877.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13080.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19825.7},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13095.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":13973.75},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7123.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7123.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12048.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22470.59},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31393.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13671.6},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16632.16},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17693.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7399.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12824.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7399.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7123.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16442.0},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7399.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13865.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7192.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7690.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9128.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7399.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13652.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7330.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14850.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18041.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7261.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16819.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14850.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6915.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7399.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9063.99,"10th_percentile":9063.99,"90th_percentile":9063.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without Cc/Mcc","code_information":[{"code":"148","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7260.02,"maximum":33294.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11801.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21073.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7768.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20019.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13872.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21025.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13888.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14819.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7477.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7477.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12778.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23830.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33294.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14499.25},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17639.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18764.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7768.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13600.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7768.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7477.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17437.36},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7768.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14704.9},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7260.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7550.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8073.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9583.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7768.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14332.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7695.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7260.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15749.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19133.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7623.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17837.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15749.1},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7260.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7768.22,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Cc","code_information":[{"code":"147","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10849.47,"maximum":53109.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18824.56},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33615.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11608.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31934.99},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22129.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":33539.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22154.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23639.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11174.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11174.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20383.42},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38014.04},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":53109.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23128.59},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28137.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29932.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11608.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21695.6},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11608.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11174.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27815.33},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11608.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23456.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10849.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11283.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12064.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14321.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11608.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21417.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11500.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10849.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25122.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30521.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11391.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28453.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25122.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10849.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11608.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy With Mcc","code_information":[{"code":"146","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17249.79,"maximum":88441.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31348.11},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55979.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18457.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53180.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":36851.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":55852.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":36893.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39366.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":33944.04},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63303.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":88441.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38515.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":46855.94},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49845.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18457.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36129.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18457.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17767.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46320.24},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18457.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39061.8},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17249.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17939.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19181.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22769.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18457.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34052.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18284.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17249.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":41835.59},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50826.07},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18112.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47383.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":41835.59},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17249.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18457.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10325.88,"maximum":50218.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17800.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31786.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11048.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30196.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20924.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31714.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20948.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22353.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10635.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10635.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19274.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35945.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50218.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21869.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26605.7},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28303.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11048.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20514.84},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11048.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10635.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26301.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11048.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22180.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10325.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10738.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11482.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13630.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11048.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20384.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10945.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10325.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23755.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28860.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10842.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26905.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23755.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10325.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11048.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Cc","code_information":[{"code":"144","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14340.55,"maximum":72381.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25655.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45814.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15344.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43523.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30159.39},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45710.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30194.05},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32218.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14770.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14770.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27780.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51808.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72381.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31521.45},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38347.34},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40794.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15344.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29568.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15344.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14770.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37908.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15344.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31968.54},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14340.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14914.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15946.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18929.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15344.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28309.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15200.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14340.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34238.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41596.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15057.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38778.84},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34238.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14340.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15344.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures With Mcc","code_information":[{"code":"143","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29576.79,"maximum":156491.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55468.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99052.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31647.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":94099.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":65205.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":98827.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":65280.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":69656.79},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30464.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30464.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":60061.74},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":112012.1},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":156491.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":68150.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":82908.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88198.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31647.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":63928.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31647.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30464.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":81960.62},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31647.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69117.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29576.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30759.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32889.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39041.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31647.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58387.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31351.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29576.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":74025.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89933.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31055.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":83841.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":74025.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29576.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31647.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without Cc/Mcc","code_information":[{"code":"142","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13307.75,"maximum":66680.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23634.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42205.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14239.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40095.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27783.75},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42109.84},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27815.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29680.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13706.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13706.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25591.89},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47727.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":66680.03},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29038.52},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35326.74},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37580.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14239.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27239.37},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14239.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13706.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":34922.85},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14239.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29450.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13307.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13840.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14798.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17566.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14239.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26270.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14106.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13307.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31541.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38319.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13973.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35724.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31541.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13307.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14239.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Cc","code_information":[{"code":"141","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17731.76,"maximum":91102.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32291.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57663.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18972.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54780.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37959.86},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57533.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38003.49},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40551.01},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18263.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18263.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34965.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65208.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91102.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39674.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48265.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51345.28},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18972.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37216.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18972.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18263.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":47713.74},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18972.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40236.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18441.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23405.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18972.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35004.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18795.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43094.17},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52355.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18618.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48808.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43094.17},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17731.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18972.98,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With Mcc","code_information":[{"code":"140","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33501.43,"maximum":178157.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":63147.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112766.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35846.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":107127.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":74233.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":112510.08},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":74318.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":79300.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34506.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34506.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":68377.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":127519.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":178157.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":77585.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":94386.82},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100409.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35846.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":72778.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35846.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34506.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":93307.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35846.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78686.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33501.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34841.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37253.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44221.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35846.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":66135.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35511.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33501.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":84273.8},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102384.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35176.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":95448.88},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":84273.8},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33501.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35846.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures","code_information":[{"code":"139","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10578.59,"maximum":51613.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18294.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32669.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11319.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31035.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21506.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32595.29},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21530.84},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22974.13},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10895.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10895.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19809.51},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36943.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51613.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22477.38},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":27344.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29089.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11319.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21084.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11319.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10895.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27032.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11319.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22796.19},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10578.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11001.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11763.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13963.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11319.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20883.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11213.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10578.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24414.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29661.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11107.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27652.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24414.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10578.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11319.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without Cc/Mcc","code_information":[{"code":"138","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7934.18,"maximum":37015.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13120.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23429.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8489.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22257.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15423.42},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23376.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15441.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16476.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8172.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8172.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14206.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26494.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37015.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16119.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19610.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20862.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8489.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15121.23},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8489.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8172.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19386.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8489.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16348.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7934.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8251.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8822.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10473.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8489.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15662.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8410.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7934.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17509.54},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8330.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":19831.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17509.54},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7934.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8489.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With Cc/Mcc","code_information":[{"code":"137","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12526.91,"maximum":62369.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22106.83},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39477.22},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":37503.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":25987.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":39387.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26017.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27761.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23937.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":44642.2},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":62369.47},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27161.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33043.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35151.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":25478.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12902.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":32665.24},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27546.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12526.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13027.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13929.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16535.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13403.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24729.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13278.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12526.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":29502.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35842.77},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13153.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":33414.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":29502.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12526.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13403.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without Cc/Mcc","code_information":[{"code":"136","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8910.98,"maximum":42408.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15031.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26842.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9534.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25500.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17670.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26781.58},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17690.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18876.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9178.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9178.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16276.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30354.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42408.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18468.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22467.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23901.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9534.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17324.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9534.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9178.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22210.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9534.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18730.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8910.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9267.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9909.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11762.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9534.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17591.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9445.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8910.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20060.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24371.26},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9356.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22720.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20060.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8910.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9534.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures With Cc/Mcc","code_information":[{"code":"135","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17647.78,"maximum":90638.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32126.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57370.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":54501.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37766.68},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57240.26},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37810.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40344.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18177.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18177.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34787.27},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":64876.49},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":90638.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39472.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48019.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51083.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37026.71},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18177.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":47470.92},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40032.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18353.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19624.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23295.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18883.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34838.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18706.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42874.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52088.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18530.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":48560.26},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42874.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17647.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18883.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7038.33,"maximum":32070.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11367.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20299.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7531.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19284.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13362.79},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20253.03},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13378.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14274.94},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7249.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7249.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12308.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22954.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32070.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13966.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16990.65},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18074.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7531.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13100.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7531.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7249.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16796.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7531.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14164.37},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7038.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7319.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7826.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9290.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7531.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13894.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7460.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7038.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15170.19},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18430.27},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7390.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17181.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15170.19},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7038.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7531.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":7399.24,"10th_percentile":7399.24,"90th_percentile":7399.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11239.89,"maximum":55264.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19588.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34980.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12026.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33230.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23027.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34900.73},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23053.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24599.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11577.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11577.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21210.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":39556.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":55264.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24067.19},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29278.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31147.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12026.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22576.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12026.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11577.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28944.14},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12026.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24408.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11239.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11689.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12498.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14836.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12026.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22188.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11239.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26141.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31759.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11801.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29608.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26141.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11239.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12026.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12414.84,"10th_percentile":12414.84,"90th_percentile":12414.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7271.37,"maximum":33356.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11823.27},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21113.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7780.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20057.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13898.83},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21065.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13914.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14847.57},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7489.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7489.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12802.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23875.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33356.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14526.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17672.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18799.84},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7780.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13626.51},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7780.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7489.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17470.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7780.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14732.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7271.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7562.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8085.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9598.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7780.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14354.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7707.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7271.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15778.74},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19169.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7634.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17871.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15778.74},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7271.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7780.37,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":7649.35,"10th_percentile":7649.35,"90th_percentile":7649.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":21065.47,"10th_percentile":21065.47,"90th_percentile":21065.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":18976.34,"10th_percentile":18976.34,"90th_percentile":18976.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7174.52,"maximum":32822.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11633.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20774.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7676.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19736.15},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13676.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20727.83},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13691.78},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14609.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7389.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7389.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12597.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23493.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32822.08},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14293.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17388.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18498.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7676.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13408.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7676.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7389.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17190.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7676.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14496.44},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7174.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7461.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7978.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9470.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7676.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14163.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7604.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7174.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15525.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18862.34},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7533.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17584.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15525.84},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7174.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7676.74,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections With Cc/Mcc","code_information":[{"code":"121","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10030.79,"maximum":48589.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17222.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30755.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10732.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29217.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20246.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":30685.53},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20269.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21628.07},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10331.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10331.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18648.86},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":34779.18},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":48589.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21160.43},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":25742.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27385.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10732.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19849.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10732.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10331.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25448.35},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10732.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21460.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10432.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11154.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13240.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10732.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19801.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10632.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22984.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27923.85},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10532.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26032.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22984.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10030.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10732.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11072.66,"10th_percentile":11072.66,"90th_percentile":11072.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures Without Cc/Mcc","code_information":[{"code":"117","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9437.6,"maximum":45315.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16061.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28682.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10098.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27248.35},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":18881.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28617.49},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":18903.3},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20170.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9720.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9720.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17392.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32435.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45315.19},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19734.33},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24007.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25539.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10098.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18511.65},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10098.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9720.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23733.27},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10098.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20014.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9437.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9815.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10494.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12457.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10098.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18630.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10003.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9437.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21435.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26041.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9909.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24277.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21435.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9437.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10098.23,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With Cc/Mcc","code_information":[{"code":"116","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14909.54,"maximum":75522.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26768.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47802.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15953.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45412.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31468.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47694.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31504.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33616.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15356.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15356.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28985.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54056.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75522.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32889.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40011.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42564.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15953.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30851.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15953.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15356.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39554.0},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15953.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33355.83},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14909.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15505.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16579.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19680.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15953.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29432.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15804.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14909.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35724.44},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43401.63},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15655.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40461.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35724.44},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14909.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15953.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extraocular Procedures Except Orbit","code_information":[{"code":"115","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12842.43,"maximum":64111.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22724.19},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40579.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13741.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38550.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26713.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40487.59},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26744.1},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28536.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13227.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13227.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24605.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45888.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64111.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27919.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33965.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36133.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13741.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26190.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13741.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13227.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33577.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13741.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28315.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12842.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13356.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14280.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16952.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13741.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25352.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13612.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12842.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30326.55},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36843.74},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13484.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34347.99},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30326.55},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12842.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13741.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without Cc/Mcc","code_information":[{"code":"114","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11466.12,"maximum":56513.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20031.17},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35770.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12268.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33981.95},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23547.61},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35689.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23574.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25154.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11810.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11810.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21689.94},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40450.64},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56513.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24611.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29940.54},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31850.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12268.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23086.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12268.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11810.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29598.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12268.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24960.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11924.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12750.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15135.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12268.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22635.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12154.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26732.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32477.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30277.43},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26732.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11466.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12268.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With Cc/Mcc","code_information":[{"code":"113","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19018.03,"maximum":98203.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34808.04},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62158.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20349.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":59050.23},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40918.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":62017.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40965.57},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43711.65},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19588.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19588.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37690.48},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":70290.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":98203.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42766.51},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":52027.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55347.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20349.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40116.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20349.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19588.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":51432.66},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20349.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43373.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19018.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19778.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21148.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25103.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20349.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37543.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20159.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19018.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":46453.03},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56435.8},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19968.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":52612.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":46453.03},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19018.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20349.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Headaches Without Mcc","code_information":[{"code":"103","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7556.62,"maximum":34931.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12381.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22110.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8085.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":21004.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14554.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":22059.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14571.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15548.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7783.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7783.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13406.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":25002.86},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34931.41},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15212.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18506.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19687.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8085.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14269.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8085.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7783.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18294.9},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8085.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15428.06},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7556.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7858.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8402.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9974.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8085.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14917.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8010.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7556.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16523.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20074.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7934.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18714.72},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16523.62},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7556.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8085.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"1 through 10","median_amount":12381.42,"10th_percentile":12381.42,"90th_percentile":12381.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":434.3,"10th_percentile":434.3,"90th_percentile":8344.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4709.73,"10th_percentile":4709.73,"90th_percentile":4709.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"1 through 10","median_amount":20074.55,"10th_percentile":20074.55,"90th_percentile":20074.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7954.99,"10th_percentile":7954.99,"90th_percentile":7954.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":7756.51,"10th_percentile":7756.51,"90th_percentile":7756.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Headaches With Mcc","code_information":[{"code":"102","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9709.98,"maximum":46818.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16594.92},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29634.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10389.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":28152.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19508.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":29567.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19530.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20839.77},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10001.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10001.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17969.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":33511.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":46818.87},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":20389.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24804.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26387.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10389.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":19125.92},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10389.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10001.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24520.81},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10389.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20678.36},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9709.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10098.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10797.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12817.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10389.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19168.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10292.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9709.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":22146.74},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26906.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10195.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":25083.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":22146.74},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9709.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10389.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3363.07,"10th_percentile":3363.07,"90th_percentile":3363.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures Without Mcc","code_information":[{"code":"101","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8058.26,"maximum":37700.7,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13362.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23862.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8622.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22669.7},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15708.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23808.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15726.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16781.14},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8300.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8300.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14469.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26985.03},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37700.7},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16418.29},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19973.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21248.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8622.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15401.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8622.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8300.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19745.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8622.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16651.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8058.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8380.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8960.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10636.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8622.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15907.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8541.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8058.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17833.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21666.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8461.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20198.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17833.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8058.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8622.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":17670.44,"10th_percentile":17670.44,"90th_percentile":17670.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8894.44,"10th_percentile":8894.44,"90th_percentile":8894.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6481.09,"10th_percentile":6481.09,"90th_percentile":6481.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Seizures With Mcc","code_information":[{"code":"100","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15883.32,"maximum":80898.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28674.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51205.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16995.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48644.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33708.07},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51088.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33746.8},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36008.99},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16359.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16359.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31048.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57904.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80898.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35230.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42859.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45594.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16995.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33047.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16995.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16359.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42369.44},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16995.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35730.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15883.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16518.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17662.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20965.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16995.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31355.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16836.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15883.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38267.29},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46490.95},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16677.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43341.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38267.29},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15883.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16995.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11537.24,"maximum":56906.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20170.33},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36019.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":34218.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23711.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35937.39},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23738.46},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25329.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11883.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11883.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21840.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40731.67},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56906.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24782.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30148.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32072.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23246.63},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11883.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29803.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25133.56},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11998.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12829.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15229.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12344.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22775.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12229.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26918.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32703.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12114.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30487.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26918.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11537.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12344.85,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18592.81,"maximum":95855.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33975.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60672.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19894.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":57638.71},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39940.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60534.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39986.34},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42666.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19150.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19150.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36789.54},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68610.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95855.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41744.23},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":50783.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54024.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19894.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39157.88},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19894.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19150.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":50203.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19894.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42336.32},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18592.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19336.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20675.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24542.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19894.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36704.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19708.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18592.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45342.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55086.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19522.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":51355.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45342.63},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18592.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19894.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Mcc","code_information":[{"code":"097","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28556.86,"maximum":150861.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":53472.7},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95488.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30555.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":90713.97},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":62859.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":95272.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":62932.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":67150.59},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29413.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29413.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":57900.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":107981.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":150861.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":65698.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":79925.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85025.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30555.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":61628.14},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30555.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29413.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":79011.74},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30555.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66630.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28556.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29699.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31755.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37695.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30555.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56374.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30270.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28556.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":71361.94},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86697.65},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29984.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":80824.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":71361.94},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28556.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30555.84,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without Cc/Mcc","code_information":[{"code":"096","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20743.9,"maximum":107730.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38185.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68188.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":64779.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44888.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68034.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44939.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47952.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41347.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77110.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107730.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46915.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":57075.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60716.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":44008.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":56422.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47581.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20743.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23067.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27381.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40950.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21988.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20743.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50959.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61911.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21781.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":57717.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":50959.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20743.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Cc","code_information":[{"code":"095","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20743.9,"maximum":107730.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":38185.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68188.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":64779.19},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":44888.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":68034.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":44939.98},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":47952.49},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":41347.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":77110.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":107730.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":46915.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":57075.12},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60716.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":44008.89},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21366.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":56422.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47581.08},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20743.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23067.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27381.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40950.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21988.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20743.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":50959.83},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61911.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21781.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":57717.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":50959.83},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20743.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22195.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18928.11,"10th_percentile":18928.11,"90th_percentile":18928.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System With Mcc","code_information":[{"code":"094","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27857.73,"maximum":147001.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":52104.72},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93045.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29807.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":88393.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":61251.64},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":92834.73},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":61322.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":65432.68},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28693.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28693.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":56419.5},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":105219.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":147001.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":64017.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":77880.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82850.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29807.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":60051.52},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29807.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28693.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":76990.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29807.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64925.89},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27857.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28972.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30977.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36772.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29807.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54993.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29529.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27857.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":69536.31},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84479.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29250.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":78757.13},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":69536.31},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27857.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29807.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10444.2,"10th_percentile":10444.2,"90th_percentile":10444.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without Cc/Mcc","code_information":[{"code":"093","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7253.97,"maximum":33260.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11789.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21052.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7761.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19999.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13858.81},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21004.8},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13874.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14804.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7471.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7471.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12765.49},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23806.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":33260.65},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14484.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17621.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18745.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7761.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":13587.27},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7761.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7471.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17419.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7761.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14690.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7253.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7544.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8066.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9575.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7761.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14320.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7689.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7253.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15733.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19114.39},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7616.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17819.6},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15733.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7253.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7761.75,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":500.0,"10th_percentile":500.0,"90th_percentile":500.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Cc","code_information":[{"code":"092","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8969.24,"maximum":42729.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15145.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27046.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9597.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25693.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17804.29},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26984.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17824.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19019.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9238.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9238.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16399.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30584.63},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42729.69},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18608.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22637.97},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24082.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9597.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17455.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9597.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9238.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22379.15},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9597.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18872.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8969.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9328.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9973.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11839.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9597.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17706.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9507.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8969.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20212.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24556.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9417.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22892.69},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20212.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8969.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9597.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9905.43,"10th_percentile":9905.43,"90th_percentile":9905.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4709.73,"10th_percentile":4709.73,"90th_percentile":4709.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7421.4,"10th_percentile":7421.4,"90th_percentile":7421.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With Mcc","code_information":[{"code":"091","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14516.85,"maximum":73354.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26000.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46430.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15533.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44108.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30564.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46325.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30600.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32651.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14952.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14952.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28153.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52505.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73354.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31945.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38862.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41342.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15533.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29966.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15533.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14952.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38418.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15533.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32398.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14516.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15097.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16142.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19162.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15533.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28657.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15387.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14516.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34699.0},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42155.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15242.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39300.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34699.0},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14516.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15533.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":13994.96,"10th_percentile":13994.96,"90th_percentile":13994.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16030.06,"10th_percentile":16030.06,"90th_percentile":16030.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":5589.64,"10th_percentile":5589.64,"90th_percentile":5589.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7457.5,"maximum":34384.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12187.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21763.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7979.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20675.49},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14326.97},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21714.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14343.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15304.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7681.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7681.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13196.72},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24611.21},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34384.24},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":14974.01},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18216.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19378.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7979.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14046.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7979.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7681.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18008.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7979.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15186.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7755.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8292.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9843.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7979.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14721.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7904.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16264.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19760.09},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7830.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18421.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16264.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7457.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7979.52,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Cc","code_information":[{"code":"089","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9541.26,"maximum":45887.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16264.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29044.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10209.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27592.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":19120.03},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28978.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19142.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20425.17},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9827.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9827.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17611.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32844.84},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45887.42},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":19983.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24310.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25862.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10209.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":18745.41},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10209.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9827.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":24032.97},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10209.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20266.97},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9541.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9922.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10609.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12594.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10209.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18835.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10113.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9541.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21706.14},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26370.79},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10018.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24584.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21706.14},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9541.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10209.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion With Mcc","code_information":[{"code":"088","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11457.04,"maximum":56463.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20013.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35738.89},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":33951.81},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":23526.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":35657.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":23553.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25132.67},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11800.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11800.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":21670.71},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":40414.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":56463.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":24589.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":29913.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31822.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23065.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11800.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":29571.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24938.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11457.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11915.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12740.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15123.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12259.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22617.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12144.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11457.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":26708.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32448.61},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12029.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":30250.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":26708.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11457.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12259.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without Cc/Mcc","code_information":[{"code":"087","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8149.82,"maximum":38206.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13542.13},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24182.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22973.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15919.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24127.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15937.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17006.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8394.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8394.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14663.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27346.79},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38206.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16638.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20241.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21532.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15607.53},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8394.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20009.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16874.39},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8149.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8475.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9062.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10757.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8720.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16088.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8638.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8149.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18072.64},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21956.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8557.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20469.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18072.64},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8149.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8720.31,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Cc","code_information":[{"code":"086","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11085.54,"maximum":54412.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19286.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34440.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11861.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32718.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22672.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34362.62},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22698.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24219.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20883.58},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38946.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54412.48},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23696.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28827.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30666.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11861.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22227.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11861.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11418.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28497.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11861.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24032.21},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11085.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11528.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12327.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14632.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11861.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21883.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11750.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11085.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25738.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31270.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11639.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29151.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25738.75},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11085.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11861.53,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14531.91,"10th_percentile":14531.91,"90th_percentile":14531.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With Mcc","code_information":[{"code":"085","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18418.78,"maximum":94894.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33635.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60064.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19708.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":57061.04},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39540.15},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59928.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39585.59},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42239.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18971.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18971.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36420.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67922.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94894.99},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41325.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":50274.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53482.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19708.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38765.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19708.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18971.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":49700.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19708.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41912.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18418.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19155.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20481.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24312.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19708.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36360.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19523.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18418.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44888.2},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54534.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19339.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50840.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44888.2},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18418.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19708.09,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without Cc/Mcc","code_information":[{"code":"084","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8460.79,"maximum":39922.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14150.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25269.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9053.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24005.87},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16634.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25212.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16653.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17770.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8714.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8714.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15322.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28575.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39922.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17386.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21150.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22500.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9053.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16308.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9053.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8714.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20909.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9053.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17632.6},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8799.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9408.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11168.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9053.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16702.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8968.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18884.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22943.02},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8883.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21388.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18884.7},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8460.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9053.05,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Cc","code_information":[{"code":"083","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11789.96,"maximum":58301.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20664.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36902.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12615.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35056.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24292.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":36818.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24320.42},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":25950.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12143.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12143.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22376.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41730.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58301.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25389.6},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":30887.66},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32858.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12615.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23816.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12615.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12143.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30534.52},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12615.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25749.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11789.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12261.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13110.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15562.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12615.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23274.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12497.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11789.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27578.22},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33504.78},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12379.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31235.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27578.22},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11789.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12615.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18522.44,"maximum":95467.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33838.31},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60426.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19819.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":57405.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":39778.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":60289.56},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39824.29},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":42493.88},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19078.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19078.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36640.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":68332.58},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":95467.23},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":41575.06},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":50578.04},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53805.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19819.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":38999.19},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19819.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19078.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":49999.79},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19819.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42164.75},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18522.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19263.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20596.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24449.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19819.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36565.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19633.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18522.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45158.88},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54863.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19448.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":51147.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45158.88},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18522.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19819.01,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":750.0,"10th_percentile":750.0,"90th_percentile":750.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8005.3,"maximum":37408.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13259.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23677.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8565.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22493.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15587.02},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23624.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15604.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16651.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8245.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8245.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14357.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26775.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37408.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16290.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19818.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21083.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8565.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15281.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8565.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8245.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19592.15},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8565.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16522.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8005.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8325.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8901.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10567.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8565.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15803.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8485.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8005.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17695.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21497.98},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8405.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20041.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17695.26},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8005.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8565.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14923.91,"maximum":75601.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26797.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47852.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15968.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45459.96},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31501.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47744.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31537.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33651.52},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15371.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15371.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29016.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54113.57},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75601.89},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32923.9},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40053.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42609.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15968.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30884.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15968.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15371.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39595.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15968.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33390.88},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14923.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15520.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16595.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19699.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15968.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29461.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15819.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14923.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35761.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43447.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15670.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40504.18},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35761.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14923.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15968.58,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13567.68,"10th_percentile":13567.68,"90th_percentile":13567.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7472.63,"maximum":34467.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":12217.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21816.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7995.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":20725.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":14361.78},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":21767.13},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":14378.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":15342.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7696.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7696.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":13228.78},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":24671.0},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":34467.78},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":15010.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":18260.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19426.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7995.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":14080.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7995.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7696.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":18052.08},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7995.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15223.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7472.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7771.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8309.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9863.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7995.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14751.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7920.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7472.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":16304.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19808.1},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7846.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":18466.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":16304.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7472.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7995.71,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With Cc/Mcc","code_information":[{"code":"075","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15737.29,"maximum":80092.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28388.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50694.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16838.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48159.93},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33372.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50579.82},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33410.52},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35650.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16209.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16209.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30739.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57327.5},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":80092.06},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":34879.33},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42432.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45139.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16838.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":32718.3},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16838.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16209.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":41947.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16838.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35374.04},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15737.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16366.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17499.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20773.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16838.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31066.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16681.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15737.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37885.97},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46027.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16524.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42909.82},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37885.97},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15737.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16838.9,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9028.26,"maximum":43055.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15260.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27252.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9660.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25889.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17940.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":27190.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17960.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":19164.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9299.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9299.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16524.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30817.83},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":43055.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18750.25},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22810.57},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24266.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9660.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17588.54},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9660.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9299.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22549.78},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9660.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19016.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9028.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9389.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10039.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11917.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9660.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17822.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9569.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9028.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20366.55},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24743.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9479.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":23067.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20366.55},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9028.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9660.24,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"1 through 10","median_amount":25418.5,"10th_percentile":25418.5,"90th_percentile":25418.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3467.96,"10th_percentile":3467.96,"90th_percentile":3467.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With Mcc","code_information":[{"code":"073","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13367.53,"maximum":67010.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":23751.66},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42414.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14303.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40293.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":27921.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42318.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":27953.32},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":29827.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13768.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13768.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":25718.53},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":47963.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67010.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29182.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35501.55},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37766.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14303.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27374.17},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14303.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13768.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35095.67},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14303.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29596.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13367.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13902.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14864.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17645.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14303.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26388.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14169.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13367.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":31697.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38509.62},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14035.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":35901.03},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":31697.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13367.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14303.26,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13793.82,"10th_percentile":13793.82,"90th_percentile":13793.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6950.56,"maximum":31585.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11195.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19992.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7437.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":18992.72},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":13160.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":19947.04},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13176.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14059.27},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7159.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7159.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12122.64},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":22608.11},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":31585.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":13755.28},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":16733.95},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17801.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7437.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":12903.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7437.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7159.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":16542.63},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7437.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13950.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6950.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7228.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7729.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9174.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7437.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13721.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7367.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6950.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":14941.0},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18151.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7298.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":16922.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":14941.0},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6950.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7437.1,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8873.15,"maximum":42199.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14957.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26710.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9494.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25374.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17583.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26649.69},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17603.47},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18783.5},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9139.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9139.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16196.12},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30204.94},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42199.22},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18377.36},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22356.93},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23783.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9494.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17238.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9494.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9139.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22101.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9494.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18638.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8873.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9228.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9866.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11712.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9494.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17516.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9405.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8873.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19961.51},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24251.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9316.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22608.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19961.51},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8873.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9494.27,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7879.73,"10th_percentile":7879.73,"90th_percentile":7879.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9799.54,"10th_percentile":9799.54,"90th_percentile":11636.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9341.62,"10th_percentile":9341.62,"90th_percentile":9341.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":9169.56,"10th_percentile":9169.56,"90th_percentile":9169.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Mcc","code_information":[{"code":"064","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16444.74,"maximum":83997.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":29772.86},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53166.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17595.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":50508.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":34999.44},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":53046.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":35039.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":37388.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16938.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16938.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":32238.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":60122.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":83997.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":36580.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":44501.42},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47340.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17595.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":34313.69},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17595.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16938.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":43992.64},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17595.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37098.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17102.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18286.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21707.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17595.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32463.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17431.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":39733.34},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48272.04},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17266.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":45002.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":39733.34},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16444.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17595.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16633.39,"10th_percentile":16633.39,"90th_percentile":18158.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25607.02,"10th_percentile":25607.02,"90th_percentile":25607.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent Without Cc/Mcc","code_information":[{"code":"063","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11850.49,"maximum":58635.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":20783.26},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37113.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12680.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":35257.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":24431.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":37029.44},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":24459.81},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":26099.45},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12206.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":12206.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":22504.32},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":41969.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":58635.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":25535.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":31064.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33046.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12680.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":23953.04},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12680.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12206.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":30709.53},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12680.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25897.3},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11850.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12324.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13177.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15642.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12680.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23394.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12561.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11850.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":27736.28},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33696.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12443.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":31414.24},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":27736.28},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11850.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12680.02,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"1 through 10","median_amount":12470.87,"10th_percentile":12470.87,"90th_percentile":12470.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Cc","code_information":[{"code":"062","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14524.41,"maximum":73396.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26015.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46456.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15541.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44133.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30582.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46351.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30617.45},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32669.86},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14960.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14960.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28169.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52535.01},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73396.49},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31963.47},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38885.08},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41366.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15541.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29983.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15541.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14960.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38440.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15541.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32416.83},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14524.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15105.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16151.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19172.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15541.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28672.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15395.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14524.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34718.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42179.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15250.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39322.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34718.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14524.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15541.12,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ischemic Stroke, Precerebral Occlusion Or Transient Ischemia With Thrombolytic Agent With Mcc","code_information":[{"code":"061","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22089.95,"maximum":115161.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40818.87},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72892.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23636.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":69247.32},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47984.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72726.78},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":48039.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":51260.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22752.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22752.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":44199.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":82429.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":115161.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":50151.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":61011.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64904.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23636.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":47044.4},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23636.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22752.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":60314.32},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23636.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50862.98},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22089.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22973.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24564.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":29158.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23636.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43607.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23415.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22089.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54474.78},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66181.43},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23194.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":61698.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":54474.78},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22089.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23636.25,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia Without Cc/Mcc","code_information":[{"code":"060","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8188.4,"maximum":38419.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13617.64},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24317.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8761.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23101.7},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16008.2},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24262.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16026.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17100.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8434.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8434.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14745.31},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":27499.26},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":38419.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16731.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20354.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21653.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8761.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15694.55},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8761.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8434.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20121.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8761.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16968.47},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8515.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9105.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10808.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8761.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16164.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8679.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18173.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22078.88},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8597.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20583.28},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18173.41},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8188.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8761.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Cc","code_information":[{"code":"059","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10617.94,"maximum":51831.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18371.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32806.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11361.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":31166.44},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":21596.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32732.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21621.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":23070.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10936.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10936.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19892.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":37099.19},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51831.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":22571.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":27459.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29212.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11361.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":21173.48},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11361.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10936.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":27145.93},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11361.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22892.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10617.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11042.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11807.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14015.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11361.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20960.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11255.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10617.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24517.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29786.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11148.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27768.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24517.7},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10617.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11361.2,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Sclerosis And Cerebellar Ataxia With Mcc","code_information":[{"code":"058","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14163.5,"maximum":71404.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25309.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45195.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15154.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":42935.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29752.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45093.19},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29786.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31783.02},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14588.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14588.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27404.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51108.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71404.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31095.81},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37829.53},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40243.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15154.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29169.2},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15154.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14588.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37397.02},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15154.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31536.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14163.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14730.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15749.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18695.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15154.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27960.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15013.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14163.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33776.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41034.84},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14871.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38255.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33776.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14163.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15154.95,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without Mcc","code_information":[{"code":"057","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11031.81,"maximum":54115.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19181.36},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34253.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11804.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32540.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22548.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34175.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22574.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24087.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11362.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11362.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20769.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38734.55},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54115.92},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23566.96},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28670.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30499.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11804.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22106.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11804.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11362.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28342.55},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11804.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23901.23},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11031.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11473.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12267.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14561.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11804.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21777.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11693.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11031.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25598.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31099.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11583.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28992.94},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25598.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11031.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11804.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12178.59,"10th_percentile":12178.59,"90th_percentile":12178.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":4709.73,"10th_percentile":4709.73,"90th_percentile":4709.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With Cc/Mcc","code_information":[{"code":"949","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10230.54,"maximum":49692.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17613.51},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31453.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10946.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29880.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20705.54},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31381.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20729.33},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22118.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10537.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10537.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19072.08},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35568.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49692.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21640.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26326.87},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28006.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10946.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20299.85},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10946.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10537.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26025.88},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10946.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21947.59},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10230.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10639.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11376.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13504.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10946.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20196.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10844.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10230.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23506.09},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28557.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10742.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26623.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23506.09},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10230.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10946.68,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5978.29,"maximum":26218.4,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9293.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16595.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6396.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":15765.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":10924.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":16557.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":10937.04},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":11670.2},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6157.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":6157.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10062.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":18766.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":26218.4},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":11417.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":13890.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14776.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6396.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":10710.45},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6396.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6157.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":13731.57},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6396.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11579.81},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5978.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6217.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6647.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7891.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6396.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11801.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6336.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5978.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":12402.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15067.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6277.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14046.67},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":12402.1},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5978.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6396.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5435.79,"maximum":23223.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":8231.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14699.53},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5816.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":13964.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":9676.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":14666.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":9687.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":10337.15},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5598.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":5598.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":8913.24},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":16622.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":23223.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":10113.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":12303.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13088.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5816.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":9487.03},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5816.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5598.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":12163.06},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5816.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10257.09},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5653.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6044.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":7175.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5816.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10730.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5761.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":10985.45},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13346.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5707.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":12442.17},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":10985.45},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5435.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5816.3,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"1 through 10","median_amount":5086.49,"10th_percentile":5086.49,"90th_percentile":5086.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52158.38,"maximum":281151.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":99653.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177956.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55809.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":169058.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":117148.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":177552.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":117282.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":125144.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":53723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":107906.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":201239.7},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":281151.32},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":122438.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":148952.51},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158456.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55809.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":114852.76},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55809.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53723.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":147249.54},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55809.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124175.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52158.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54244.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58000.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":68849.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55809.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102965.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55287.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52158.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":132993.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161573.32},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54766.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":150628.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":132993.07},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52158.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55809.47,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant Trauma","code_information":[{"code":"956","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29700.88,"maximum":157176.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":55711.22},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99486.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":94511.51},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":65491.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":99260.41},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":65566.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":69961.7},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30591.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30591.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":60324.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":112502.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":157176.75},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":68448.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":83271.43},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88584.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":64208.07},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30591.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":82319.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69419.82},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29700.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30888.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33027.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":39205.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31779.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58632.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31482.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29700.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":74349.35},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90327.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31185.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":84208.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":74349.35},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29700.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31779.94,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"1 through 10","median_amount":3331.46,"10th_percentile":3331.46,"90th_percentile":3331.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29613.68,"10th_percentile":29613.68,"90th_percentile":29613.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38949.2,"10th_percentile":38949.2,"90th_percentile":38949.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Mcc","code_information":[{"code":"957","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":58883.3,"maximum":318275.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":112812.62},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201454.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63005.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":191381.41},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":132616.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":200997.72},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":132769.14},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":141669.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60649.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":60649.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":122154.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":227812.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":318275.6},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":138605.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":168620.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179380.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63005.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":130018.35},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63005.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60649.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":166692.93},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63005.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140571.92},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58883.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61238.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65478.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":77725.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63005.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":116241.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62416.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58883.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":150553.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":182908.08},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61827.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":170518.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":150553.98},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58883.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63005.13,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33112.52,"maximum":176010.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62386.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111407.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35430.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":105836.31},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":73338.72},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111154.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":73422.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":78344.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34105.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34105.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67553.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":125982.97},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":176010.39},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":76650.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":93249.39},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99199.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35430.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71901.78},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35430.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34105.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":92183.28},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35430.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77738.03},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33112.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34437.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36821.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43708.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35430.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65367.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35099.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33112.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":83258.24},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101150.46},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34768.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":94298.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":83258.24},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33112.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35430.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23504.84,"maximum":122972.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":43587.4},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77836.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":73944.02},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":51239.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":77659.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":51298.0},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":54736.71},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24209.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24209.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":47196.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":88019.76},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":122972.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":53553.18},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":65149.99},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69307.06},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":50235.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24209.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":64405.13},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54312.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23504.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24445.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26137.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31026.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25150.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46400.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24915.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23504.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":58169.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70670.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24680.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":65883.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":58169.53},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23504.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25150.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Mcc","code_information":[{"code":"963","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21913.65,"maximum":114188.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":40473.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72276.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23447.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":68662.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":47579.06},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":72112.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":47633.73},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":50826.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22571.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22571.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":43825.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":81732.42},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":114188.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":49727.82},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":60496.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64356.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23447.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":46646.83},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23447.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22571.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":59804.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23447.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50433.14},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21913.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22790.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24367.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":28926.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23447.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43259.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23228.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21913.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":54014.42},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65622.14},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23009.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":61176.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":54014.42},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21913.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23447.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major Problems","code_information":[{"code":"791","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":31940.5,"maximum":169540.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":60093.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107311.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34176.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":101945.84},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":70642.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":107068.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":70724.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":75464.93},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32898.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32898.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":65069.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":121351.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":169540.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":73833.21},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":89821.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95552.92},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34176.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":69258.72},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34176.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32898.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":88794.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34176.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74880.43},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31940.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33218.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35517.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":42161.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34176.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63053.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33856.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31940.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":80197.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97432.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33537.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":90832.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":80197.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31940.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34176.34,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With Cc","code_information":[{"code":"964","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12825.03,"maximum":64015.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22690.14},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40518.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13722.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38492.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26673.37},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40426.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26704.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28494.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13209.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13209.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24569.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45820.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64015.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27877.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33914.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36078.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13722.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26150.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13722.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13209.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33527.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13722.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28273.4},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12825.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13338.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14261.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16929.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13722.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25317.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13594.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12825.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30281.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36788.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13466.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34296.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30281.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12825.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13722.78,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8345.03,"maximum":39283.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13924.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24864.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":23621.6},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":16368.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":24808.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":16387.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":17485.78},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15077.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":28118.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":39283.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17107.7},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":20812.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22140.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16047.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8595.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":20574.38},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17350.34},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8345.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8678.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9279.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11015.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8929.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16473.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8845.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8345.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":18582.4},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22575.76},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8762.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21046.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":18582.4},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8345.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8929.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures With Mcc","code_information":[{"code":"969","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":47544.46,"maximum":255680.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":90625.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161834.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50872.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":153742.57},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":106535.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":161467.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":106657.53},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":113807.21},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48970.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":48970.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":98130.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":183008.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":255680.58},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":111346.45},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":135458.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144101.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50872.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":104447.74},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50872.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48970.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":133909.56},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50872.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112925.74},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47544.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49446.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52869.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":62758.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50872.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":93857.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50397.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47544.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":120944.65},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146935.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49921.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":136982.45},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":120944.65},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47544.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50872.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Extensive O.R. Procedures Without Mcc","code_information":[{"code":"970","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21184.26,"maximum":110161.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39046.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69727.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22667.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":66240.94},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":45901.31},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":69569.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":45954.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49034.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21819.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21819.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42280.16},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":78850.35},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":110161.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":47974.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":58363.02},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62087.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22667.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":45001.96},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22667.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21819.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":57695.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22667.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48654.76},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21184.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22031.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23556.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27963.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22667.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41819.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21184.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52109.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63308.15},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22243.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":59019.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":52109.75},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21184.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22667.16,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23065.24,"maximum":120545.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42727.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76300.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24679.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72484.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50227.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76126.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50285.66},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53656.51},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23757.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23757.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46265.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86282.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120545.33},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52496.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":63864.29},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67939.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24679.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49243.82},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24679.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23757.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":63134.14},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24679.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53240.93},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23065.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23987.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25648.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30446.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24679.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45533.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24449.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23065.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":57021.59},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69275.54},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24218.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64582.91},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":57021.59},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23065.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24679.81,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11027.28,"maximum":54090.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19172.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34237.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11799.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32525.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22538.18},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34159.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22564.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24076.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11358.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11358.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20760.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38716.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54090.86},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23556.05},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28657.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30485.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11799.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22096.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11799.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11358.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28329.42},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11799.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23890.16},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11027.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11468.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12262.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14556.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11799.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21768.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11688.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11027.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25586.61},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31085.18},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11578.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":28979.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25586.61},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11027.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11799.19,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8059.02,"maximum":37704.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":13364.47},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23865.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8623.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":22672.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":15710.59},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":23811.42},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":15728.64},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":16783.0},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8300.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8300.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":14471.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":26988.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":37704.88},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":16420.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":19975.85},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21250.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8623.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":15402.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8623.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8300.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":19747.47},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8623.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16653.01},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8059.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8381.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8961.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10637.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8623.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15909.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8542.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8059.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":17835.55},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21668.41},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8461.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":20200.62},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":17835.55},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8059.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8623.15,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related Condition","code_information":[{"code":"977","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11047.7,"maximum":54203.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":19212.45},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34308.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11821.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":32593.03},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":22585.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":34230.73},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":22611.12},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":24126.84},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":20803.43},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":38797.34},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":54203.63},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":23605.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":28716.8},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30549.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11821.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":22142.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11821.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11379.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":28388.49},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11821.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23939.97},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11047.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11489.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12285.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14582.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11821.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21809.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11710.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11047.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":25639.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31149.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11600.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":29039.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":25639.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11047.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11821.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"981","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36728.45,"maximum":195971.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":69462.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124041.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39299.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":117839.25},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":81656.09},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":123760.3},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":81749.92},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":87229.95},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37830.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37830.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":75214.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":140270.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":195971.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":85343.84},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":103824.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110449.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39299.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":80056.18},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39299.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37830.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":102637.82},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39299.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86554.33},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36728.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38197.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40842.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":48481.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39299.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72505.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38932.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36728.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":92700.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112621.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38564.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":104993.1},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":92700.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36728.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39299.44,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":9992.23,"10th_percentile":9992.23,"90th_percentile":9992.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"982","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19830.65,"maximum":102689.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":36398.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64997.82},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21218.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":61747.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":42787.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":64850.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":42836.9},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":45708.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20425.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20425.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":39412.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":73501.77},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":102689.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":44720.12},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":54404.15},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57875.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21218.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":41949.39},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21218.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20425.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":53782.15},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21218.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45354.41},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19830.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20623.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22051.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26176.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21218.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39147.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21020.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19830.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":48575.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59013.83},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20822.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":55016.31},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":48575.04},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19830.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21218.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14197.55,"maximum":71592.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25375.77},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45314.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15191.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43048.82},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":29830.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45211.89},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":29864.74},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":31866.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14623.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14623.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27477.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51243.46},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":71592.07},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31177.66},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":37929.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40349.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15191.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29245.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15191.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14623.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37495.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15191.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31619.87},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14197.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14765.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15787.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18740.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15191.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28027.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15049.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14197.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":33865.21},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41142.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14907.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38355.89},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":33865.21},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14197.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15191.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Mcc","code_information":[{"code":"987","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27169.2,"maximum":143200.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50757.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90640.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29071.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":86107.69},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":59667.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":90434.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":59736.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":63740.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":54960.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":102498.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":143200.84},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":62362.6},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":75867.06},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80707.96},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29071.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":58498.79},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29071.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27984.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":74999.68},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29071.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63247.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27169.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28255.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30212.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35863.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29071.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53634.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28799.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27169.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":67738.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82295.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28527.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":76720.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":67738.33},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27169.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29071.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27326.26,"10th_percentile":27326.26,"90th_percentile":27326.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28039.66,"10th_percentile":28039.66,"90th_percentile":28039.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis With Cc","code_information":[{"code":"988","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13664.88,"maximum":68651.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24333.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43453.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14621.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41280.66},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28605.21},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43354.88},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28638.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30557.81},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14074.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14074.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26348.55},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49138.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68651.53},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29897.08},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36371.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38691.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14621.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28044.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14621.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14074.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35955.39},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14621.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30321.13},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13664.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15195.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18037.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14621.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26975.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14484.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13664.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32474.25},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39452.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14348.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36780.48},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32474.25},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13664.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14621.42,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3930.56,"10th_percentile":3930.56,"90th_percentile":3930.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"989","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10302.42,"maximum":50089.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17754.16},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31704.45},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11023.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30119.11},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20870.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31632.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20894.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22295.53},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10611.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10611.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19224.38},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35852.48},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50089.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21813.45},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26537.1},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28230.37},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11023.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20461.95},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11023.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10611.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26233.7},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11023.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22122.84},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10302.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10714.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11456.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13599.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11023.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20338.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10920.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10302.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23693.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28785.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10817.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26835.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23693.79},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10302.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11023.59,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock With Mcc","code_information":[{"code":"222","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":113355.96,"maximum":319808.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":113355.96},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202425.19},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":192303.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":201965.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":133408.6},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":142351.51},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":122742.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":228909.37},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":319808.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":169432.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":180244.02},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":167495.78},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141248.96},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":151279.1},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183789.03},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":171339.39},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":151279.1}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization With Ami, Hf Or Shock Without Mcc","code_information":[{"code":"223","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":77262.85,"maximum":217979.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":77262.85},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137971.99},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":131072.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":137658.87},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":90930.63},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":97026.07},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":83660.98},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":156023.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":217979.88},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":115484.61},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122853.42},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":114164.28},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96274.58},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":103111.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":125269.67},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":116784.07},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":103111.07}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock With Mcc","code_information":[{"code":"224","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":104955.61,"maximum":296108.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":104955.61},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187424.27},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":178052.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":186998.92},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":123522.22},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":131802.41},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":113646.97},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":211945.81},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":296108.79},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":156876.91},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":166886.86},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":155083.34},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130781.56},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":140068.41},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":170169.16},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":158642.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":140068.41}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization Without Ami, Hf Or Shock Without Mcc","code_information":[{"code":"225","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74879.25,"maximum":211255.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74879.25},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133715.47},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":127029.19},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":133412.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":88125.36},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":94032.76},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":81079.99},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":151210.06},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":211255.07},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":111921.84},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119063.32},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":110642.25},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93304.45},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":99930.04},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121405.03},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":113181.21},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":99930.04}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization With Mcc","code_information":[{"code":"226","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":94765.32,"maximum":267359.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":94765.32},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169226.99},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":160765.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":168842.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":111529.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":119005.53},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":102612.83},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":191367.71},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":267359.19},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":141645.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150683.59},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":140026.09},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118083.8},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":126468.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153647.2},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":143239.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":126468.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Cardiac Catheterization Without Mcc","code_information":[{"code":"227","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":74331.46,"maximum":209709.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":74331.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132737.27},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":126099.9},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":132436.02},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":87480.68},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":93344.85},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":80486.84},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":150103.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":209709.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":111103.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118192.3},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":109832.83},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92621.87},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":99198.99},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120516.88},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":112353.22},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":99198.99}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"246","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44346.9,"maximum":125114.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44346.9},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79192.39},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":75232.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79012.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52191.85},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":55690.48},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":48019.26},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":89553.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":125114.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":66285.21},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70514.71},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":65527.37},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55259.14},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59183.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71901.58},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":67031.06},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":59183.11}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With Mcc","code_information":[{"code":"056","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18806.18,"maximum":97033.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":34393.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61418.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20122.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":58346.98},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":40431.23},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":61278.73},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":40477.69},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":43191.08},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19370.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19370.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":37241.62},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":69453.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":97033.56},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":42257.19},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":51407.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54688.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20122.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":39639.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20122.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19370.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":50820.14},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20122.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42856.55},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18806.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19558.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20912.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":24824.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20122.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37125.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19934.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18806.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":45899.81},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55763.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19746.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":51986.33},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":45899.81},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18806.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20122.61,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without Mcc","code_information":[{"code":"055","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8943.52,"maximum":42587.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":15095.18},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26956.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9569.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25608.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17745.12},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26895.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17765.51},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18956.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9211.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":9211.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":16345.21},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":30482.98},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":42587.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":18546.52},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22562.73},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24002.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9569.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":17397.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9569.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9211.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":22304.77},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9569.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18809.58},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8943.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9301.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9945.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11805.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9569.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17655.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9480.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8943.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":20145.26},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24474.48},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9390.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22816.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":20145.26},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8943.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9569.57,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With Mcc","code_information":[{"code":"054","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12781.9,"maximum":63777.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22605.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40368.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13676.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38349.62},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":26574.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40276.57},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26604.71},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28388.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13165.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13165.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24477.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":45649.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":63777.09},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":27774.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":33788.77},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35944.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13676.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":26053.49},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13676.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13165.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33402.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13676.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28168.25},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12781.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13293.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14213.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16872.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13676.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25232.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13548.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12781.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30168.49},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36651.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13421.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34168.97},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30168.49},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12781.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13676.63,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14110.66,"10th_percentile":14110.66,"90th_percentile":14110.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without Cc/Mcc","code_information":[{"code":"053","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8637.84,"maximum":40900.2,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14497.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25888.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9242.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":24593.59},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":17042.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":25829.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17061.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18205.29},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8896.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":8896.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15697.56},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29275.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":40900.2},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":17811.65},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":21668.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23051.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9242.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":16708.09},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9242.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8896.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21420.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9242.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18064.28},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8637.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8983.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9605.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":11401.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9242.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17051.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9156.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8637.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19347.03},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23504.72},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9069.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":21912.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19347.03},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8637.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9242.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With Cc/Mcc","code_information":[{"code":"052","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14933.75,"maximum":75656.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26816.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47887.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15979.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45492.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":31523.87},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47778.47},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31560.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33675.69},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15381.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":15381.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29036.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54152.44},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75656.19},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":32947.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40082.26},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42639.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15979.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":30906.21},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15979.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15381.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39624.0},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15979.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33414.86},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14933.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15531.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16606.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19712.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15979.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29480.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15829.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14933.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35787.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43478.45},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15680.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40533.27},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35787.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14933.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15979.11,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without Cc/Mcc","code_information":[{"code":"042","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14301.21,"maximum":72164.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":25578.6},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45676.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15302.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":43392.91},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":30068.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":45573.27},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30103.44},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32121.4},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14730.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14730.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":27696.76},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":51653.05},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":72164.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":31426.86},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38232.27},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40671.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15302.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":29479.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15302.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14730.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":37795.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15302.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31872.61},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14301.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14873.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15902.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18877.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15302.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28232.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15159.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14301.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34135.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41471.71},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15016.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":38662.47},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34135.9},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14301.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15302.29,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral Neurostimulator","code_information":[{"code":"041","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17864.93,"maximum":91837.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32551.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58129.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19115.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":55222.55},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38266.17},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57997.31},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38310.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40878.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18400.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18400.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35247.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65734.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91837.5},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39994.35},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48655.03},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51759.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19115.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37516.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19115.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18400.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":48098.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19115.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40561.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17864.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18579.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19865.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23581.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19115.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35267.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18936.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17864.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43441.91},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52777.59},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18758.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49202.51},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43441.91},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17864.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19115.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":16319.64,"10th_percentile":16319.64,"90th_percentile":16319.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Mcc","code_information":[{"code":"040","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30443.89,"maximum":161278.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57165.07},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102082.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32574.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":96977.9},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":67200.32},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":101850.73},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":67277.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":71787.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31357.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31357.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":61898.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":115438.3},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":161278.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":70235.23},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":85444.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90896.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32574.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":65883.66},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32574.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31357.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":84467.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32574.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71231.42},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30443.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31661.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33853.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":40185.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32574.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60099.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32270.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30443.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":76289.59},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92684.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31966.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":86405.93},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":76289.59},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30443.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32574.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without Cc/Mcc","code_information":[{"code":"039","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10123.1,"maximum":49099.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17403.28},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31077.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10831.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":29523.86},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":20458.4},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31007.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20481.91},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":21854.9},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":10426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":18844.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35143.92},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":49099.46},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":21382.35},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26012.64},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27672.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10831.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":20057.56},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10831.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10426.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":25715.24},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10831.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21685.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10123.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10528.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11256.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13362.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10831.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19984.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10730.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10123.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23225.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28216.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10629.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26305.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23225.53},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10123.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10831.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Cc","code_information":[{"code":"038","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13505.99,"maximum":67774.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24022.59},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42898.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14451.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40753.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28239.73},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42800.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28272.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30167.38},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13911.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":13911.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26011.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48510.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":67774.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":29515.09},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":35906.52},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38197.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14451.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":27686.42},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14451.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13911.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35496.0},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14451.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29933.72},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13505.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14046.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15018.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17827.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14451.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26662.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14316.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13505.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32059.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38948.89},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14181.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36310.54},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32059.33},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13505.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14451.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With Mcc","code_information":[{"code":"037","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26137.91,"maximum":137507.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":48739.54},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87036.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27967.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":82684.38},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":57295.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":86839.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":57361.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":61206.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26922.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26922.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":52775.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":98423.91},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":137507.72},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":59883.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":72850.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77499.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27967.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":56173.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27967.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26922.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":72017.98},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27967.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60732.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26137.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27183.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29065.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34502.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27967.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51598.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27706.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26137.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":65045.31},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79023.57},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27444.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":73670.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":65045.31},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26137.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27967.56,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures Without Cc/Mcc","code_information":[{"code":"036","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15928.72,"maximum":81148.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28763.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51363.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17043.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":48795.36},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":33812.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":51247.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33851.35},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":36120.54},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16406.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":16406.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":31145.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":58083.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":81148.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":35339.53},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42992.22},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45735.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17043.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":33150.0},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17043.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16406.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":42500.69},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17043.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35840.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15928.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16565.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17712.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":21025.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17043.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31444.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16884.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15928.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":38385.84},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46634.97},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16725.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":43475.98},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":38385.84},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15928.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17043.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Cc","code_information":[{"code":"035","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19316.15,"maximum":99848.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":35391.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63200.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20668.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":60039.8},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":41604.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":63056.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":41652.07},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":44444.18},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19895.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":19895.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":38322.11},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":71468.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":99848.79},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":43483.2},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":52899.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56274.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20668.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":40789.1},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20668.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19895.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":52294.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20668.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44099.94},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19316.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20088.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21479.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25497.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20668.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38132.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20475.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19316.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":47231.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57381.56},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20281.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":53494.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":47231.5},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19316.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20668.28,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With Mcc","code_information":[{"code":"034","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30515.77,"maximum":161675.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57305.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102333.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32651.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":97216.5},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":67365.66},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":102101.32},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":67443.08},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":71964.05},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31431.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31431.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":62051.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":115722.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":161675.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":70408.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":85654.72},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91120.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32651.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":66045.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32651.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31431.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":84675.43},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32651.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71406.67},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30515.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31736.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33933.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":40280.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32651.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60241.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32346.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30515.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":76477.29},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92912.28},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32041.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":86618.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":76477.29},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30515.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32651.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without Cc/Mcc","code_information":[{"code":"033","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13810.91,"maximum":69457.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24619.23},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43963.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":41765.4},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":28941.11},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":43863.98},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28974.37},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30916.64},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14225.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":14225.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26657.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":49715.72},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":69457.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":30248.15},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36798.31},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39146.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":28374.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14225.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":36377.6},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14777.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30677.18},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13810.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14363.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15357.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18230.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14777.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27264.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14639.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13810.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32855.58},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39916.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14501.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":37212.38},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32855.58},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13810.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14777.67,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Cc","code_information":[{"code":"032","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17352.69,"maximum":89009.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":31549.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56339.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18567.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":53522.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":37087.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":56211.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":37130.54},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":39619.55},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":17873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":34162.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":63710.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":89009.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":38762.89},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":47156.9},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50165.87},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18567.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":36361.25},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18567.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17873.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":46617.76},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18567.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39312.69},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17352.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18046.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19296.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":22905.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18567.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34255.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18393.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17352.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":42104.3},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51152.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18220.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":47687.52},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":42104.3},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17352.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18567.38,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With Mcc","code_information":[{"code":"031","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35129.69,"maximum":187146.0,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":66333.8},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118455.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37588.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":112532.24},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":77978.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":118186.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":78068.23},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":83301.46},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":71826.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":133953.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":187146.0},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":81500.3},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":99148.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105475.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37588.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":76450.77},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37588.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36183.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":98015.42},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37588.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82656.26},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35129.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36534.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39064.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":46371.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37588.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69349.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37237.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35129.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":88525.72},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107549.92},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36886.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":100264.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":88525.72},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35129.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37588.77,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without Cc/Mcc","code_information":[{"code":"030","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17838.45,"maximum":91691.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":32499.94},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58036.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19087.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":55134.64},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":38205.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":57904.99},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":38249.16},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":40813.16},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18373.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":18373.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":35191.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":65629.89},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":91691.31},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":39930.69},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":48577.58},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51677.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19087.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":37456.7},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19087.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18373.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":48022.2},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19087.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40497.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17838.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18551.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19836.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23546.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19087.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35214.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18908.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17838.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":43372.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52693.58},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18730.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":49124.19},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":43372.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17838.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19087.14,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27042.08,"maximum":142499.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":50508.74},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":90195.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28935.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":85685.75},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":59375.49},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":89991.18},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":59443.72},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":63428.47},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27853.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":27853.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":54691.36},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":101996.61},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":142499.12},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":62057.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":75495.3},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80312.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28935.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":58212.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28935.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27853.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":74632.16},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28935.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62937.2},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27042.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28123.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30070.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":35695.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28935.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53383.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28664.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27042.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":67406.39},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81892.05},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28394.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":76344.78},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":67406.39},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27042.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28935.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46689.47,"maximum":250960.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":88952.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158847.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49957.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":150904.46},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":104568.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":158486.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":104688.62},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":111706.31},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":48090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":96319.06},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":179630.15},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":250960.68},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":109290.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":132957.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141441.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49957.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":102519.62},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49957.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48090.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":131437.57},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49957.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110841.12},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46689.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48557.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51918.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":61630.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49957.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92169.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49490.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46689.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":118711.99},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144223.23},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49023.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":134453.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":118711.99},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46689.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49957.73,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without Cc/Mcc","code_information":[{"code":"027","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20317.92,"maximum":105379.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":37351.53},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66700.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21740.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":63365.16},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":43908.55},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":66549.06},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":43959.01},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":46905.76},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20927.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":20927.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":40444.61},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":75427.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":105379.01},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":45891.55},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":55829.25},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59391.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21740.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":43048.24},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21740.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20927.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":55190.96},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21740.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46542.46},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20317.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21130.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22593.53,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26819.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21740.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40109.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21537.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20317.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":49847.46},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60559.69},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21333.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":56457.46},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":49847.46},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20317.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21740.17,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Cc","code_information":[{"code":"026","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24754.04,"maximum":129868.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":46031.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82201.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26486.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":78090.67},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":54112.52},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":82014.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":54174.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":57806.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25496.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":25496.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":49843.59},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":92955.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":129868.17},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":56556.35},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":68803.49},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73193.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26486.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":53052.28},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26486.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25496.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":68016.86},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26486.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57358.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24754.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25744.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27526.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":32675.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26486.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48866.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26239.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24754.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":61431.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74633.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25991.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":69577.68},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":61431.57},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24754.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26486.82,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With Mcc","code_information":[{"code":"025","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35630.58,"maximum":189911.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":67313.89},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120205.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38124.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":114194.92},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":79130.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":119932.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":79221.7},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":84532.25},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36699.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":36699.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":72888.15},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":135932.69},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":189911.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":82704.47},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":100613.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107033.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38124.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":77580.34},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38124.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36699.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":99463.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38124.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83877.52},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35630.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37055.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39621.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47032.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38124.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70338.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37768.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35630.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":89833.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109138.99},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37412.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":101746.05},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":89833.7},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35630.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38124.72,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis Without Mcc","code_information":[{"code":"024","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30827.5,"maximum":163396.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":57915.68},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103422.81},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32985.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":98251.28},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":68082.71},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":103188.1},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":68160.95},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":72730.04},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31752.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":31752.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":62711.67},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":116954.07},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":163396.15},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":71157.46},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":86566.44},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92090.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32985.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":66748.75},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32985.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31752.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":85576.72},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32985.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72166.73},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30827.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32060.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34280.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":40692.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32985.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60856.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32677.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30827.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":77291.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93901.25},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32368.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":87540.5},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":77291.32},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30827.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32985.43,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy With Major Device Implant Or Acute Complex Cns Principal Diagnosis With Mcc Or Antineopla","code_information":[{"code":"023","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44586.04,"maximum":239348.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":84837.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151497.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47707.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":143922.21},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":99730.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":151153.85},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":99844.75},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":106537.74},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45923.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":45923.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":91862.44},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":171318.78},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":239348.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":104234.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":126805.81},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134896.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47707.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":97776.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47707.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45923.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":125356.04},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47707.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105712.57},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44586.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46369.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49579.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":58853.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47707.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":88017.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47261.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44586.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":113219.27},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137550.12},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46815.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":128232.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":113219.27},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44586.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47707.06,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25270.06,"maximum":132716.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":47041.41},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84004.1},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27038.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":79803.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":55299.47},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":83813.46},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":55363.02},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":59074.22},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26028.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":26028.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":50936.9},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":94994.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":132716.82},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":57796.91},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":70312.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74799.17},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27038.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":54215.98},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27038.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26028.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":69508.8},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27038.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58616.68},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25270.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26280.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28100.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":33356.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27038.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49885.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26786.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25270.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":62779.07},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76270.31},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26533.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":71103.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":62779.07},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25270.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27038.96,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Cc","code_information":[{"code":"021","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41283.35,"maximum":221116.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":78374.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139957.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44173.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":132959.08},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":92133.3},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":139639.86},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":92239.17},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":98422.33},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42521.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":42521.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":84864.91},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":158268.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":221116.73},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":96294.22},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":117146.5},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124621.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44173.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":90328.11},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44173.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42521.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":115807.17},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44173.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97660.02},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41283.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42934.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45907.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":54494.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44173.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":81497.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43760.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41283.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":104594.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127072.38},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43347.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":118464.66},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":104594.9},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41283.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44173.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage With Mcc","code_information":[{"code":"020","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":60766.55,"maximum":328671.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":116497.58},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208035.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65020.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":197632.78},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":136948.6},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":207563.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":137105.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":146296.73},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":62589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":126144.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":235253.51},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":328671.91},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":143133.47},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":174128.68},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":185239.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65020.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":134265.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65020.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62589.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":172137.87},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65020.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145163.62},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60766.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63197.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67572.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":80211.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65020.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":119959.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64412.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60766.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":155471.75},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188882.68},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63804.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":176088.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":155471.75},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60766.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65020.21,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant With Hemodialysis","code_information":[{"code":"019","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55211.38,"maximum":298005.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":105627.75},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188624.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59076.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":179192.61},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":124170.58},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":188196.48},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":124313.27},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":132646.48},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56867.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56867.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":114374.77},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":213303.14},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":298005.11},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":129778.37},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":157881.56},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167955.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59076.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":121737.68},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59076.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56867.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":156076.51},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59076.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131619.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55211.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57419.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61395.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":72879.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59076.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108992.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58524.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55211.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":140965.43},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171258.94},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57971.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":159658.08},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":140965.43},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55211.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59076.18,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chimeric Antigen Receptor (Car) T-Cell And Other Immunotherapies","code_information":[{"code":"018","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":327962.51,"maximum":1803702.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":639321.35},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1141666.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":350919.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":1084579.2},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":751553.45},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":1139075.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":752417.11},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":802854.62},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":337801.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":337801.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":692263.47},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":1291036.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":1803702.37},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":785495.13},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":955592.18},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1016566.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":350919.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":736828.12},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":350919.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":337801.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":944666.93},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":350919.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":796636.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327962.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":341081.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364694.31,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":432910.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":350919.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":647430.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":347640.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327962.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":853205.76},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1036559.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":344360.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":966344.7},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":853205.76},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":327962.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":350919.89,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant Without Cc/Mcc","code_information":[{"code":"017","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42331.29,"maximum":226901.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80425.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143619.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45294.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":136437.65},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":94543.75},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":143293.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":94652.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":100997.32},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43601.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43601.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":87085.2},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":162409.47},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":226901.74},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":98813.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":120211.37},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127881.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45294.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":92691.33},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45294.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43601.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":118836.99},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45294.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100215.07},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42331.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44024.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47072.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":55877.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45294.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83566.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44871.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42331.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":107331.38},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130396.93},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44447.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":121564.01},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":107331.38},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42331.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45294.48,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Autologous Bone Marrow Transplant With Cc/Mcc","code_information":[{"code":"016","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46094.76,"maximum":247677.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":87789.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156769.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49321.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":148930.35},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":103200.5},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":156413.63},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":103319.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":110244.98},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47477.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47477.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":95059.02},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":177280.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":247677.64},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":107861.24},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":131218.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139591.07},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49321.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":101178.47},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49321.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47477.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":129718.12},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49321.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109391.11},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46094.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47938.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51257.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":60845.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49321.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":90995.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48860.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46094.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":117159.01},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142336.52},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48399.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":132694.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":117159.01},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46094.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49321.39,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allogeneic Bone Marrow Transplant","code_information":[{"code":"014","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":92159.84,"maximum":501975.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":177925.01},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":317729.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98611.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":301841.58},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":209159.53},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":317008.17},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":209399.89},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":223436.8},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94924.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":94924.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":192658.95},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":359299.16},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":501975.67},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":218605.6},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":265944.11},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":282913.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98611.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":205061.43},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98611.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94924.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":262903.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98611.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221706.22},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92159.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95846.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102481.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":121650.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98611.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181932.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97689.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92159.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":237449.67},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288477.67},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96767.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":268936.57},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":237449.67},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92159.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98611.03,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy Without Cc/Mcc","code_information":[{"code":"013","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23033.46,"maximum":120369.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":42665.05},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76189.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24645.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":72379.29},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":50154.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":76016.12},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":50212.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":53578.43},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23724.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":23724.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":46198.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":86157.17},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":120369.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":52419.94},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":63771.35},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67840.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24645.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":49172.15},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24645.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23724.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":63042.26},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24645.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53163.45},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23033.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23954.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25613.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":30404.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24645.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45470.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24415.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23033.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":56938.6},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69174.73},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24185.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":64488.92},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":56938.6},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23033.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24645.8,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Cc","code_information":[{"code":"012","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33128.41,"maximum":176098.1,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":62417.88},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111462.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35447.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":105889.06},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":73375.26},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":111209.65},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":73459.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":78383.87},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34122.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":34122.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":67586.7},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":126045.75},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":176098.1},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":76689.04},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":93295.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99248.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35447.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":71937.61},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35447.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34122.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":92229.22},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35447.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77776.77},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33128.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34453.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36838.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43729.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35447.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65398.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35116.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33128.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":83299.73},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101200.86},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34784.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":94345.65},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":83299.73},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33128.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35447.4,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy For Face, Mouth And Neck Diagnoses Or Laryngectomy With Mcc","code_information":[{"code":"011","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":42496.23,"maximum":227812.3,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":80747.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":144195.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45470.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":136985.18},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":94923.16},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":143868.25},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":95032.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":101402.63},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43771.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":43771.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":87434.68},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":163061.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":227812.3},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":99210.08},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":120693.78},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128394.97},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45470.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":93063.31},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45470.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43771.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":119313.89},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45470.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100617.24},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42496.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44196.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47255.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":56095.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45470.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83891.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45046.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42496.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":107762.11},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130920.22},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44621.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":122051.85},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":107762.11},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42496.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45470.97,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Drug-Eluting Stent Without Mcc","code_information":[{"code":"247","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28270.15,"maximum":79757.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":28270.15},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50483.36},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":47959.0},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":50368.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":33271.13},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":35501.42},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":30611.19},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":57088.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":79757.91},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":42255.33},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44951.54},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":41772.22},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35226.46},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":37727.9},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45835.64},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":42730.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":37727.9}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent With Mcc Or 4+ Arteries Or Stents","code_information":[{"code":"248","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":44560.09,"maximum":125716.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":44560.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79573.09},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":75594.14},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":79392.5},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":52442.76},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":55958.2},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":48250.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":89983.99},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":125716.34},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":66603.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70853.7},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":65842.38},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55524.79},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":59467.63},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72247.24},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":67353.3},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":59467.63}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Non-Drug-Eluting Stent Without Mcc","code_information":[{"code":"249","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26896.24,"maximum":75881.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26896.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48029.91},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":45628.24},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":47920.91},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":31654.18},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":33776.09},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":29123.52},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":54313.88},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":75881.74},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":40201.75},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42766.93},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":39742.13},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33514.48},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":35894.36},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43608.07},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":40654.11},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":35894.36}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Mcc","code_information":[{"code":"338","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":39329.48,"maximum":110959.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":39329.48},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70232.55},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":66720.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":70073.16},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":46286.86},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":49389.65},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":42586.35},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":79421.38},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":110959.35},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":58785.69},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62536.67},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":58113.59},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49007.11},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":52487.13},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63766.63},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":59447.16},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":52487.13}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis With Cc","code_information":[{"code":"339","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24108.46,"maximum":68016.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":24108.46},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43051.64},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":40898.89},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":42953.94},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":28373.24},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":30275.21},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":26104.88},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":48684.27},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":68016.64},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":36034.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38334.16},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":35622.88},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30040.72},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":32173.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39088.11},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":36440.34},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":32173.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy With Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"340","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":17764.52,"maximum":50118.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":17764.52},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31722.96},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30136.69},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":31650.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":20907.06},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22308.54},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19235.6},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":35873.41},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":50118.62},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":26552.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28246.85},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26249.01},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22135.76},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":23707.62},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28802.4},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":26851.36},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":23707.62}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Mcc","code_information":[{"code":"341","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33444.5,"maximum":94356.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":33444.5},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59723.44},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":56737.04},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":59587.9},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":39360.82},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":41999.33},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":36214.03},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":67537.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":94356.17},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":49989.41},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53179.12},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":49417.88},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41674.03},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":44633.32},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54225.04},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":50551.9},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":44633.32}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis With Cc","code_information":[{"code":"342","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21514.63,"maximum":60698.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":21514.63},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38419.7},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":36498.57},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":38332.51},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":25320.56},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":27017.89},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":23296.25},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":43446.32},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":60698.71},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":32157.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34209.78},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":31790.2},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26808.63},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":28712.33},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34882.61},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":32519.71},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":28712.33}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendectomy Without Complicated Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"343","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16177.42,"maximum":45640.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":16177.42},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28888.8},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":27444.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":28823.24},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":19039.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":20315.48},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":17517.07},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":32668.45},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":45640.99},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":24180.36},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25723.25},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":23903.91},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20158.13},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":21589.57},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26229.17},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":24452.44},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":21589.57}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Mcc","code_information":[{"code":"453","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":131193.03,"maximum":370131.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":131193.03},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":234277.69},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":222562.92},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":233746.01},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":154401.03},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":164751.15},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":142057.1},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":264929.28},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":370131.82},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":196093.92},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208606.22},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":193851.99},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":163475.11},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":175083.54},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212709.05},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":198300.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":175083.54}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion With Cc","code_information":[{"code":"454","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":90551.82,"maximum":255471.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":90551.82},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161702.74},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":153616.99},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":161335.76},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":106570.41},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":113714.25},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":98050.41},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":182859.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":255471.73},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":135347.6},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143983.82},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":133800.18},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112833.5},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":120845.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146815.67},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":136870.56},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":120845.86}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Spinal Fusion Without Cc/Mcc","code_information":[{"code":"455","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":68185.91,"maximum":192371.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68185.91},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121762.85},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":115674.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":121486.52},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":80247.97},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":85627.32},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":73832.37},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":137693.62},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":192371.31},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":101917.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108420.43},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":100752.11},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84964.11},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":90997.44},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110552.82},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":103064.12},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":90997.44}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Mcc","code_information":[{"code":"459","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":98191.2,"maximum":277024.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":98191.2},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":175344.75},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":166576.85},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":174946.81},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":115561.2},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":123307.72},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":106322.4},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":198285.87},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":277024.54},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":146766.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":156130.97},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":145088.19},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122352.67},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":131040.98},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":159201.73},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":148417.61},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":131040.98}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"460","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":54155.21,"maximum":152786.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":54155.21},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96707.56},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":91871.82},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":96488.09},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":63735.25},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":68007.68},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":58639.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":109360.24},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":152786.83},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":80945.67},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86110.62},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":80020.22},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67480.94},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":72272.79},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87804.23},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":81856.49},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":72272.79}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Mcc","code_information":[{"code":"077","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22891.49,"maximum":64583.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":22891.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40878.44},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":38834.36},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":40785.66},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":26940.99},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":28746.95},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":24787.13},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":46226.74},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":64583.23},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":34215.86},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36399.09},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":33824.67},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28524.3},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":30549.82},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37114.98},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":34600.86},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":30549.82}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15262.88,"10th_percentile":15262.88,"90th_percentile":15262.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy With Cc","code_information":[{"code":"078","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14772.43,"maximum":41677.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":14772.43},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26379.84},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":25060.74},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":26319.97},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":17385.67},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":18551.1},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":15995.73},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":29831.23},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":41677.11},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":22080.32},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23489.21},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":21827.87},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18407.41},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":19714.53},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23951.19},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":22328.77},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":19714.53}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hypertensive Encephalopathy Without Cc/Mcc","code_information":[{"code":"079","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9870.49,"maximum":27847.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":9870.49},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17626.21},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":16744.84},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":17586.21},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":11616.58},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":12395.29},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":10687.87},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":19932.33},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":27847.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":14753.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15694.78},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":14584.73},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12299.28},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":13172.66},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16003.47},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":14919.41},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":13172.66}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis With Cc/Mcc","code_information":[{"code":"294","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18179.06,"maximum":51288.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":18179.06},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32463.22},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":30839.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":32389.55},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":21394.93},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":22829.12},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":19684.46},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":36710.53},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":51288.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":27172.2},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28905.99},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":26861.54},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22652.3},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":24260.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29474.51},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":27477.95},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":24260.85}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis Without Cc/Mcc","code_information":[{"code":"295","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11692.99,"maximum":32989.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":11692.99},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20880.73},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":19836.62},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":20833.34},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":13761.48},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":14683.96},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":12661.28},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":23612.65},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":32989.16},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":17477.48},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18592.68},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":17277.66},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14570.23},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":15604.87},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18958.36},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":17674.14},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":15604.87}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Arthroscopy","code_information":[{"code":"509","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26004.98,"maximum":73367.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":26004.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46438.35},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":44116.25},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":46332.96},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":30605.26},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":32656.85},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":28158.45},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":52514.08},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":73367.25},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":38869.59},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41349.77},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":38425.19},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32403.91},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":34704.93},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42163.03},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":39306.96},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":34704.93}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas Transplant","code_information":[{"code":"010","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":55522.36,"maximum":299721.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":106236.24},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":189711.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59408.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":180224.88},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":124885.88},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":189280.61},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":125029.4},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":133410.61},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57188.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":57188.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":115033.65},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":214531.9},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":299721.81},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":130525.98},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":158791.07},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168923.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59408.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":122438.97},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59408.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57188.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":156975.61},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59408.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132377.31},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55522.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57743.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61740.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":73289.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59408.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":109606.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58853.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55522.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":141777.48},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172245.5},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58298.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":160577.81},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":141777.48},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55522.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59408.93,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simultaneous Pancreas And Kidney Transplant","code_information":[{"code":"008","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":43634.96,"maximum":234098.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":82976.1},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148174.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46689.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":140765.13},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":97542.46},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":147838.14},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":97654.55},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":104200.72},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44944.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":44944.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":89847.34},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":167560.73},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":234098.54},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":101947.67},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":124024.19},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131937.89},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46689.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":95631.29},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46689.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44944.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":122606.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46689.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103393.66},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43634.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45380.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48522.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":57598.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46689.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":86139.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46253.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43634.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":110735.69},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134532.82},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45816.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":125419.74},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":110735.69},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43634.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46689.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung Transplant","code_information":[{"code":"007","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":99213.9,"maximum":540916.9,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":191727.71},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":342377.39},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106158.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":325257.22},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":225385.28},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":341600.38},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":225644.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":240770.12},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102190.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":102190.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":207604.66},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":387172.13},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":540916.9},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":235564.14},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":286574.98},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304860.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106158.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":220969.26},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106158.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102190.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":283298.58},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106158.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":238905.29},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99213.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103182.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110325.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":130962.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106158.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":195858.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105166.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99213.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":255870.05},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":310856.6},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104174.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":289799.58},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":255870.05},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99213.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106158.87,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant Without Mcc","code_information":[{"code":"006","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36313.82,"maximum":193682.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":68650.79},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122593.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38855.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":116462.89},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":80702.35},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":122314.79},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":80795.09},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":86211.1},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37403.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":37403.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":74335.75},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":138632.39},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":193682.85},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":84347.03},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":102612.17},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109159.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38855.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":79121.13},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38855.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37403.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":101439.01},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38855.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85543.38},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36313.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37766.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40380.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":47934.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38855.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":71687.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38492.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36313.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":91617.85},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111306.55},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38129.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":103766.79},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":91617.85},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36313.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38855.79,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Liver Transplant With Mcc Or Intestinal Transplant","code_information":[{"code":"005","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":79241.16,"maximum":430659.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":152646.95},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272589.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84788.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":258958.52},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":179443.94},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":271970.37},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":179650.15},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":191692.82},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81618.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":81618.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":165287.63},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":308253.02},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":430659.27},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":187548.0},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":228161.05},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":242719.48},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84788.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":175928.06},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84788.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81618.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":225552.5},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84788.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190208.1},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79241.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82410.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88116.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":104598.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84788.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":156429.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83995.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79241.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":203714.86},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":247493.24},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83203.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":230728.37},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":203714.86},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79241.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84788.04,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck Without Major O.R.","code_information":[{"code":"004","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":106032.64,"maximum":578559.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":205069.98},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":366203.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":347891.76},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":241069.77},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":365372.23},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":241346.79},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":257525.23},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109213.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":109213.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":222051.79},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":414115.31},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":578559.13},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":251956.97},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":306517.63},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":326075.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":236346.44},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109213.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":303013.23},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":255530.63},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106032.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110273.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117908.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":139963.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113454.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":209319.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112394.6,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106032.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":273675.96},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":332489.01},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111334.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":309966.63},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":273675.96},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106032.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113454.92,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With Major","code_information":[{"code":"003","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":161824.94,"maximum":886555.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":314239.09},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":561151.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173152.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":533092.12},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":369403.38},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":559878.33},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":369827.88},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":394618.92},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166679.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":166679.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":340261.18},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":634569.8},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":886555.38},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":386086.39},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":469692.45},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":499662.43},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173152.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":362165.59},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173152.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166679.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":464322.48},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173152.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":391562.49},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161824.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168297.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":179949.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":213608.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173152.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":319458.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":171534.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161824.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":419367.5},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":509489.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169916.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":474977.53},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":419367.5},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161824.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173152.69,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":86968.61,"maximum":473317.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":167767.3},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299590.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93056.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":284609.49},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":197218.65},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":298910.22},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":197445.28},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":210680.83},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89577.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":89577.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":181660.09},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":338786.82},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":473317.95},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":206125.44},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":250761.4},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266761.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93056.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":193354.5},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93056.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89577.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":247894.46},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93056.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":209049.05},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86968.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90447.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96709.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":114798.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93056.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":171684.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92186.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86968.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":223893.7},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272008.53},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91317.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":253583.02},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":223893.7},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86968.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93056.41,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System With Mcc","code_information":[{"code":"001","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":213265.88,"maximum":1170530.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Adventhealth Corporate Employee","methodology":"fee schedule","standard_charge_dollar":414893.84},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":740895.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228194.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"Qhp Exchange","methodology":"fee schedule","standard_charge_dollar":703848.27},{"payer_name":"Allegiance/Health First","plan_name":"Employee Hmo","methodology":"fee schedule","standard_charge_dollar":487727.96},{"payer_name":"Bcbs","plan_name":"Blueoptions Network Blue Ppo","methodology":"fee schedule","standard_charge_dollar":739214.43},{"payer_name":"Bcbs","plan_name":"Blueselect Ppo","methodology":"fee schedule","standard_charge_dollar":488288.43},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"fee schedule","standard_charge_dollar":521020.35},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":219663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Bcbs","plan_name":"Myblue Hmo","methodology":"fee schedule","standard_charge_dollar":449251.14},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"fee schedule","standard_charge_dollar":837830.54},{"payer_name":"Bcbs","plan_name":"Traditional","methodology":"fee schedule","standard_charge_dollar":1170530.28},{"payer_name":"Cigna","plan_name":"Castcare Disney Hmo","methodology":"fee schedule","standard_charge_dollar":509754.74},{"payer_name":"Cigna","plan_name":"County Of Volusia Hmo Employee","methodology":"fee schedule","standard_charge_dollar":620140.88},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":659710.63},{"payer_name":"Cigna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228194.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Surefit Epo","methodology":"fee schedule","standard_charge_dollar":478171.81},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228194.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219663.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Florida Health Care Plan","plan_name":"Triple Option Hmo/Pos/Ppo","methodology":"fee schedule","standard_charge_dollar":613050.84},{"payer_name":"Freedom Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228194.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Health First Health Plans","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":516984.91},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213265.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221796.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237151.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Ppo","methodology":"fee schedule","standard_charge_dollar":281510.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Optimum Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228194.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":421008.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226061.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Sunshine Health","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213265.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Compass Exchange","methodology":"fee schedule","standard_charge_dollar":553696.22},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":672685.7},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":223929.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Unitedhealthcare","plan_name":"Neighborhood Health Partnership (Nhp) Hmo","methodology":"fee schedule","standard_charge_dollar":627118.83},{"payer_name":"Unitedhealthcare","plan_name":"Nexus Hmo","methodology":"fee schedule","standard_charge_dollar":553696.22},{"payer_name":"Upmc Health Plan","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213265.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228194.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tissue marker, detectable","code_information":[{"code":"2055","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1334.32,"10th_percentile":1334.32,"90th_percentile":1334.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinic Visits and Related Services","code_information":[{"code":"5012","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":107.79,"10th_percentile":107.79,"90th_percentile":107.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":300.76,"10th_percentile":300.76,"90th_percentile":300.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"12","median_amount":135.95,"10th_percentile":135.65,"90th_percentile":136.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":200.49,"10th_percentile":200.49,"90th_percentile":207.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":250.58,"10th_percentile":250.58,"90th_percentile":250.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":242.95,"10th_percentile":242.95,"90th_percentile":242.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":133.18,"10th_percentile":133.18,"90th_percentile":133.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":133.28,"10th_percentile":133.28,"90th_percentile":133.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":109.67,"10th_percentile":109.67,"90th_percentile":142.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":268.81,"10th_percentile":268.81,"90th_percentile":268.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":129.96,"10th_percentile":86.64,"90th_percentile":129.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":244.22,"10th_percentile":244.22,"90th_percentile":244.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":133.66,"10th_percentile":133.11,"90th_percentile":133.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":138.42,"10th_percentile":138.42,"90th_percentile":138.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Type A ED Visits","code_information":[{"code":"5021","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":174.61,"10th_percentile":174.61,"90th_percentile":204.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":221.7,"10th_percentile":221.7,"90th_percentile":221.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":84.04,"10th_percentile":84.04,"90th_percentile":84.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":97.3,"10th_percentile":97.3,"90th_percentile":98.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":96.51,"10th_percentile":85.67,"90th_percentile":169.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":109.85,"10th_percentile":109.85,"90th_percentile":189.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":92.8,"10th_percentile":92.8,"90th_percentile":92.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Type A ED Visits","code_information":[{"code":"5022","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":112.93,"10th_percentile":112.93,"90th_percentile":112.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":607.04,"10th_percentile":607.04,"90th_percentile":607.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":303.84,"10th_percentile":303.84,"90th_percentile":303.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":456.29,"10th_percentile":456.29,"90th_percentile":577.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":579.36,"10th_percentile":579.36,"90th_percentile":840.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.07,"10th_percentile":165.07,"90th_percentile":165.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":113.04,"10th_percentile":79.84,"90th_percentile":245.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":176.39,"10th_percentile":176.19,"90th_percentile":239.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":330.32,"10th_percentile":330.32,"90th_percentile":330.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":116.34,"10th_percentile":116.34,"90th_percentile":117.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"55","median_amount":115.24,"10th_percentile":73.66,"90th_percentile":184.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":496.33,"10th_percentile":496.33,"90th_percentile":496.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"24","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":165.77,"10th_percentile":165.77,"90th_percentile":166.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":170.09,"10th_percentile":170.09,"90th_percentile":170.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Type A ED Visits","code_information":[{"code":"5023","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":286.14,"10th_percentile":218.65,"90th_percentile":610.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"14","median_amount":925.39,"10th_percentile":747.97,"90th_percentile":2296.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":293.95,"10th_percentile":292.75,"90th_percentile":460.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"24","median_amount":1375.2,"10th_percentile":626.83,"90th_percentile":2051.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":469.72,"10th_percentile":469.72,"90th_percentile":469.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"33","median_amount":1129.63,"10th_percentile":820.39,"90th_percentile":1600.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":297.4,"10th_percentile":297.4,"90th_percentile":297.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":287.57,"10th_percentile":287.57,"90th_percentile":492.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"68","median_amount":187.68,"10th_percentile":113.04,"90th_percentile":379.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":307.38,"10th_percentile":306.56,"90th_percentile":618.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":577.56,"10th_percentile":577.56,"90th_percentile":1443.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"12","median_amount":218.98,"10th_percentile":117.7,"90th_percentile":346.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"207","median_amount":191.6,"10th_percentile":105.33,"90th_percentile":387.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"20","median_amount":1146.99,"10th_percentile":691.54,"90th_percentile":1793.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"126","median_amount":168.72,"10th_percentile":112.48,"90th_percentile":572.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":288.2,"10th_percentile":288.2,"90th_percentile":379.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":297.4,"10th_percentile":297.4,"90th_percentile":466.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Type A ED Visits","code_information":[{"code":"5024","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":346.56,"10th_percentile":247.04,"90th_percentile":521.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"16","median_amount":2762.91,"10th_percentile":1491.64,"90th_percentile":6112.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"14","median_amount":684.56,"10th_percentile":450.7,"90th_percentile":769.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"68","median_amount":2591.97,"10th_percentile":1041.62,"90th_percentile":6443.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":3212.92,"10th_percentile":3144.74,"90th_percentile":3389.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"39","median_amount":3318.87,"10th_percentile":1695.16,"90th_percentile":6832.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":683.64,"10th_percentile":666.13,"90th_percentile":21166.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":864.49,"10th_percentile":773.18,"90th_percentile":961.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"55","median_amount":346.11,"10th_percentile":198.47,"90th_percentile":428.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"93","median_amount":889.75,"10th_percentile":588.05,"90th_percentile":2912.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1163.03,"10th_percentile":1163.03,"90th_percentile":1163.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":1540.23,"10th_percentile":1110.01,"90th_percentile":2482.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"16","median_amount":375.96,"10th_percentile":170.97,"90th_percentile":595.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"165","median_amount":321.6,"10th_percentile":164.83,"90th_percentile":619.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"38","median_amount":2122.49,"10th_percentile":970.17,"90th_percentile":4688.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"91","median_amount":401.03,"10th_percentile":152.0,"90th_percentile":667.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":707.3,"10th_percentile":446.06,"90th_percentile":1038.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":698.53,"10th_percentile":571.56,"90th_percentile":997.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 5 Type A ED Visits","code_information":[{"code":"5025","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":594.84,"10th_percentile":302.92,"90th_percentile":849.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"37","median_amount":7740.24,"10th_percentile":3898.36,"90th_percentile":14002.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"33","median_amount":1342.61,"10th_percentile":959.77,"90th_percentile":2973.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"89","median_amount":9444.97,"10th_percentile":3790.5,"90th_percentile":15132.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":9550.92,"10th_percentile":9550.92,"90th_percentile":11104.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"43","median_amount":10655.77,"10th_percentile":4707.94,"90th_percentile":15999.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":1653.66,"10th_percentile":1653.66,"90th_percentile":2891.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1427.14,"10th_percentile":958.12,"90th_percentile":1569.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"43","median_amount":492.65,"10th_percentile":297.46,"90th_percentile":861.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"195","median_amount":1646.06,"10th_percentile":1009.04,"90th_percentile":6082.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":2667.24,"10th_percentile":1901.97,"90th_percentile":5932.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":12345.77,"10th_percentile":12345.77,"90th_percentile":12345.77},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"11","median_amount":733.45,"10th_percentile":368.03,"90th_percentile":1086.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":731.11,"10th_percentile":731.11,"90th_percentile":731.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"133","median_amount":466.43,"10th_percentile":280.71,"90th_percentile":878.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"47","median_amount":8988.57,"10th_percentile":3774.53,"90th_percentile":15188.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"72","median_amount":459.72,"10th_percentile":230.57,"90th_percentile":940.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"71","median_amount":1539.15,"10th_percentile":1009.99,"90th_percentile":2892.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1616.51,"10th_percentile":1042.07,"90th_percentile":3054.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Critical Care","code_information":[{"code":"5041","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1275.23,"10th_percentile":1275.23,"90th_percentile":1275.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":12588.0,"10th_percentile":12588.0,"90th_percentile":12588.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1877.04,"10th_percentile":1877.04,"90th_percentile":1877.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Skin Procedures","code_information":[{"code":"5052","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":265.71,"10th_percentile":265.71,"90th_percentile":265.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":421.64,"10th_percentile":421.64,"90th_percentile":421.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5071","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":1151.94,"10th_percentile":1151.94,"90th_percentile":1151.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":746.48,"10th_percentile":746.48,"90th_percentile":746.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":1442.34,"10th_percentile":268.71,"90th_percentile":1735.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":1453.14,"10th_percentile":1453.14,"90th_percentile":1453.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":1437.34,"10th_percentile":1437.34,"90th_percentile":1678.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":755.69,"10th_percentile":755.69,"90th_percentile":755.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":749.38,"10th_percentile":749.38,"90th_percentile":749.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":778.25,"10th_percentile":778.25,"90th_percentile":936.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":2339.14,"10th_percentile":2339.14,"90th_percentile":2339.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":729.69,"10th_percentile":729.69,"90th_percentile":729.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5072","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":3806.27,"10th_percentile":2010.54,"90th_percentile":3902.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1795.52,"10th_percentile":1795.52,"90th_percentile":1795.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":3249.35,"10th_percentile":3249.35,"90th_percentile":3249.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":2177.72,"10th_percentile":2177.72,"90th_percentile":2177.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":13167.35,"10th_percentile":4058.37,"90th_percentile":15424.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1675.75,"10th_percentile":1675.75,"90th_percentile":1675.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1791.82,"10th_percentile":1790.42,"90th_percentile":3253.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1269.92,"10th_percentile":1269.92,"90th_percentile":1269.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3379.58,"10th_percentile":3379.58,"90th_percentile":3379.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":3244.19,"10th_percentile":3244.19,"90th_percentile":3244.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1740.21,"10th_percentile":1740.21,"90th_percentile":1740.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Excision/ Biopsy/ Incision and Drainage","code_information":[{"code":"5073","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3012.49,"10th_percentile":3012.49,"90th_percentile":3012.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1206.68,"10th_percentile":1206.68,"90th_percentile":1206.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1108.69,"10th_percentile":1108.69,"90th_percentile":3164.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":3984.68,"10th_percentile":3984.68,"90th_percentile":3984.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2968.25,"10th_percentile":2968.25,"90th_percentile":2968.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Breast/Lymphatic Surgery and Related Procedures","code_information":[{"code":"5091","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":26.93,"10th_percentile":26.93,"90th_percentile":26.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":17664.61,"10th_percentile":17664.61,"90th_percentile":17664.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3970.66,"10th_percentile":3970.66,"90th_percentile":3970.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12284.84,"10th_percentile":12284.84,"90th_percentile":13691.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7987.31,"10th_percentile":7987.31,"90th_percentile":7987.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":19004.06,"10th_percentile":19004.06,"90th_percentile":19004.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6748.64,"10th_percentile":6748.64,"90th_percentile":6748.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Musculoskeletal Procedures","code_information":[{"code":"5112","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":610.28,"10th_percentile":610.28,"90th_percentile":610.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":16070.3,"10th_percentile":16070.3,"90th_percentile":16070.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":605.1,"10th_percentile":605.1,"90th_percentile":812.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Musculoskeletal Procedures","code_information":[{"code":"5113","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3621.17,"10th_percentile":3621.17,"90th_percentile":3621.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7995.07,"10th_percentile":2159.64,"90th_percentile":8110.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6767.78,"10th_percentile":6767.78,"90th_percentile":6767.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":26217.89,"10th_percentile":26217.89,"90th_percentile":26217.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":512.46,"10th_percentile":512.46,"90th_percentile":512.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7789.01,"10th_percentile":7789.01,"90th_percentile":7789.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3694.05,"10th_percentile":3694.05,"90th_percentile":3694.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Musculoskeletal Procedures","code_information":[{"code":"5114","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":4948.98,"10th_percentile":4948.98,"90th_percentile":25428.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7724.25,"10th_percentile":7724.25,"90th_percentile":7724.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":29970.57,"10th_percentile":24385.41,"90th_percentile":39541.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7899.19,"10th_percentile":195.0,"90th_percentile":27428.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3721.15,"10th_percentile":3721.15,"90th_percentile":3721.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":42271.44,"10th_percentile":42271.44,"90th_percentile":42271.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7619.06,"10th_percentile":7619.06,"90th_percentile":7622.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Musculoskeletal Procedures","code_information":[{"code":"5115","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":39998.22,"10th_percentile":39998.22,"90th_percentile":39998.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13650.15,"10th_percentile":13650.15,"90th_percentile":13650.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":24376.11,"10th_percentile":24376.11,"90th_percentile":24376.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6574.26,"10th_percentile":295.0,"90th_percentile":59379.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26889.87,"10th_percentile":26889.87,"90th_percentile":26889.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":35635.18,"10th_percentile":33889.22,"90th_percentile":36245.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13444.49,"10th_percentile":13444.49,"90th_percentile":13444.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Musculoskeletal Procedures","code_information":[{"code":"5116","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":6454.2,"10th_percentile":6454.2,"90th_percentile":6454.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19459.71,"10th_percentile":19459.71,"90th_percentile":19459.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":48038.1,"10th_percentile":48038.1,"90th_percentile":48038.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20443.63,"10th_percentile":20436.18,"90th_percentile":22056.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Airway Endoscopy","code_information":[{"code":"5153","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":11999.0,"10th_percentile":11999.0,"90th_percentile":11999.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Airway Endoscopy","code_information":[{"code":"5154","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3885.75,"10th_percentile":3885.75,"90th_percentile":3885.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Vascular Procedures","code_information":[{"code":"5181","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":4332.79,"10th_percentile":4332.79,"90th_percentile":4332.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Vascular Procedures","code_information":[{"code":"5182","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1640.99,"10th_percentile":1640.99,"90th_percentile":1640.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1718.56,"10th_percentile":1718.56,"90th_percentile":1719.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":808.11,"10th_percentile":808.11,"90th_percentile":808.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1611.08,"10th_percentile":1611.08,"90th_percentile":1637.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Vascular Procedures","code_information":[{"code":"5183","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3312.95,"10th_percentile":3312.95,"90th_percentile":3312.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3479.87,"10th_percentile":3479.87,"90th_percentile":3479.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1956.85,"10th_percentile":1956.85,"90th_percentile":1956.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3264.29,"10th_percentile":3264.29,"90th_percentile":3264.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Vascular Procedures","code_information":[{"code":"5184","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2430.77,"10th_percentile":2430.77,"90th_percentile":2430.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Endovascular Procedures","code_information":[{"code":"5191","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":19642.63,"10th_percentile":19642.63,"90th_percentile":19642.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":9133.14,"10th_percentile":9133.14,"90th_percentile":9133.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":10047.69,"10th_percentile":10047.69,"90th_percentile":10047.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Endovascular Procedures","code_information":[{"code":"5192","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6300.41,"10th_percentile":6300.41,"90th_percentile":6300.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Endovascular Procedures","code_information":[{"code":"5193","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12531.81,"10th_percentile":12531.81,"90th_percentile":12547.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Endovascular Procedures","code_information":[{"code":"5194","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19843.68,"10th_percentile":19843.68,"90th_percentile":19843.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Upper GI Procedures","code_information":[{"code":"5301","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":2109.25,"10th_percentile":1775.18,"90th_percentile":7172.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1466.66,"10th_percentile":1466.66,"90th_percentile":1466.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":7947.07,"10th_percentile":7947.07,"90th_percentile":7947.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":6916.03,"10th_percentile":6390.37,"90th_percentile":8661.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":968.95,"10th_percentile":968.95,"90th_percentile":968.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1037.98,"10th_percentile":907.28,"90th_percentile":6800.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1963.78,"10th_percentile":1963.78,"90th_percentile":1963.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":681.43,"10th_percentile":681.43,"90th_percentile":806.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":7968.94,"10th_percentile":6371.07,"90th_percentile":19778.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":254.16,"10th_percentile":181.25,"90th_percentile":740.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2493.29,"10th_percentile":2493.29,"90th_percentile":2493.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Upper GI Procedures","code_information":[{"code":"5302","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":14844.08,"10th_percentile":14844.08,"90th_percentile":14844.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":19754.78,"10th_percentile":19754.78,"90th_percentile":19754.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":660.05,"10th_percentile":660.05,"90th_percentile":660.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2100.59,"10th_percentile":2100.59,"90th_percentile":2100.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":7289.51,"10th_percentile":7289.51,"90th_percentile":7289.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1999.37,"10th_percentile":1999.37,"90th_percentile":1999.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Upper GI Procedures","code_information":[{"code":"5303","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3945.7,"10th_percentile":3945.7,"90th_percentile":3945.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Lower GI Procedures","code_information":[{"code":"5311","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":1869.25,"10th_percentile":1768.65,"90th_percentile":4951.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":7330.72,"10th_percentile":7330.72,"90th_percentile":7330.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":6174.65,"10th_percentile":6174.65,"90th_percentile":6174.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":6936.2,"10th_percentile":6936.2,"90th_percentile":6936.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":950.34,"10th_percentile":950.34,"90th_percentile":950.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3165.45,"10th_percentile":2997.07,"90th_percentile":8253.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":224.96,"10th_percentile":224.96,"90th_percentile":224.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1927.73,"10th_percentile":1927.73,"90th_percentile":1927.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Lower GI Procedures","code_information":[{"code":"5312","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"17","median_amount":2046.09,"10th_percentile":1854.14,"90th_percentile":7741.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1245.19,"10th_percentile":1241.06,"90th_percentile":2482.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":7782.63,"10th_percentile":7232.21,"90th_percentile":8547.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":6641.63,"10th_percentile":6641.63,"90th_percentile":6641.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"13","median_amount":7935.98,"10th_percentile":6819.23,"90th_percentile":11555.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":1266.39,"10th_percentile":1266.39,"90th_percentile":1266.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"30","median_amount":3203.75,"10th_percentile":1302.94,"90th_percentile":4193.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4675.07,"10th_percentile":4675.07,"90th_percentile":4675.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":668.72,"10th_percentile":668.72,"90th_percentile":668.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"11","median_amount":8119.62,"10th_percentile":3039.75,"90th_percentile":9144.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":392.89,"10th_percentile":392.89,"90th_percentile":392.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1704.04,"10th_percentile":1217.87,"90th_percentile":1864.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Lower GI Procedures","code_information":[{"code":"5313","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":15978.92,"10th_percentile":15978.92,"90th_percentile":15978.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8279.94,"10th_percentile":8279.94,"90th_percentile":8279.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":19209.64,"10th_percentile":19209.64,"90th_percentile":19209.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5341","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":25513.2,"10th_percentile":25513.2,"90th_percentile":25513.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7361.11,"10th_percentile":7361.11,"90th_percentile":7361.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2661.49,"10th_percentile":2661.49,"90th_percentile":2661.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Abdominal/Peritoneal/Biliary and Related Procedures","code_information":[{"code":"5342","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":11024.01,"10th_percentile":11024.01,"90th_percentile":11024.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":20329.81,"10th_percentile":20329.81,"90th_percentile":26217.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":2673.66,"10th_percentile":2673.66,"90th_percentile":2673.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6883.55,"10th_percentile":6883.55,"90th_percentile":6883.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Laparoscopy and Related Services","code_information":[{"code":"5361","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":4166.48,"10th_percentile":1227.39,"90th_percentile":17371.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":34338.54,"10th_percentile":22914.89,"90th_percentile":34467.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":22126.65,"10th_percentile":22126.65,"90th_percentile":22126.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3305.57,"10th_percentile":3305.57,"90th_percentile":3305.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9591.23,"10th_percentile":9591.23,"90th_percentile":9591.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12170.24,"10th_percentile":12170.24,"90th_percentile":12234.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":3627.91,"10th_percentile":3627.91,"90th_percentile":3627.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":16745.08,"10th_percentile":16745.08,"90th_percentile":16745.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":393.68,"10th_percentile":393.68,"90th_percentile":1139.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6063.22,"10th_percentile":6063.22,"90th_percentile":6063.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6266.36,"10th_percentile":6266.36,"90th_percentile":6266.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Urology and Related Services","code_information":[{"code":"5371","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":1973.9,"10th_percentile":1973.9,"90th_percentile":1973.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 5 Gynecologic Procedures","code_information":[{"code":"5415","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":16433.68,"10th_percentile":16433.68,"90th_percentile":16433.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5467.96,"10th_percentile":5467.96,"90th_percentile":5467.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Nerve Injections","code_information":[{"code":"5442","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":179.08,"10th_percentile":179.08,"90th_percentile":179.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":1230.66,"10th_percentile":1230.66,"90th_percentile":1230.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1237.55,"10th_percentile":1237.55,"90th_percentile":1237.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":718.22,"10th_percentile":718.22,"90th_percentile":718.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Neurostimulator and Related Procedures","code_information":[{"code":"5461","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3810.16,"10th_percentile":3810.16,"90th_percentile":3810.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Neurostimulator and Related Procedures","code_information":[{"code":"5464","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23703.22,"10th_percentile":23703.22,"90th_percentile":23703.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Imaging without Contrast","code_information":[{"code":"5521","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":42.71,"10th_percentile":37.37,"90th_percentile":83.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"40","median_amount":199.26,"10th_percentile":104.27,"90th_percentile":769.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"23","median_amount":92.68,"10th_percentile":92.68,"90th_percentile":214.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"41","median_amount":204.59,"10th_percentile":64.02,"90th_percentile":443.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":215.32,"10th_percentile":132.69,"90th_percentile":516.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"42","median_amount":724.46,"10th_percentile":138.03,"90th_percentile":980.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":94.57,"10th_percentile":94.57,"90th_percentile":94.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.5,"10th_percentile":91.5,"90th_percentile":91.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":36.66,"10th_percentile":36.66,"90th_percentile":54.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"139","median_amount":97.8,"10th_percentile":97.3,"90th_percentile":424.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":183.65,"10th_percentile":183.65,"90th_percentile":425.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":817.53,"10th_percentile":817.53,"90th_percentile":817.53},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":37.73,"10th_percentile":37.73,"90th_percentile":248.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"23","median_amount":56.06,"10th_percentile":37.37,"90th_percentile":110.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"35","median_amount":155.3,"10th_percentile":155.3,"90th_percentile":763.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"14","median_amount":86.18,"10th_percentile":56.24,"90th_percentile":112.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":91.32,"10th_percentile":91.32,"90th_percentile":210.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":94.57,"10th_percentile":94.57,"90th_percentile":94.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging without Contrast","code_information":[{"code":"5522","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":42.71,"10th_percentile":42.71,"90th_percentile":42.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"103","median_amount":248.39,"10th_percentile":125.55,"90th_percentile":699.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"75","median_amount":112.38,"10th_percentile":111.93,"90th_percentile":223.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"71","median_amount":249.42,"10th_percentile":114.45,"90th_percentile":742.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"14","median_amount":394.05,"10th_percentile":139.58,"90th_percentile":665.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"76","median_amount":323.89,"10th_percentile":217.0,"90th_percentile":1148.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":114.21,"10th_percentile":114.21,"90th_percentile":114.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.4,"10th_percentile":110.4,"90th_percentile":110.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"12","median_amount":69.47,"10th_percentile":36.66,"90th_percentile":71.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"295","median_amount":157.37,"10th_percentile":117.5,"90th_percentile":709.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":221.81,"10th_percentile":221.81,"90th_percentile":443.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":74.03,"10th_percentile":66.6,"90th_percentile":185.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.88,"10th_percentile":110.88,"90th_percentile":110.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"34","median_amount":65.97,"10th_percentile":37.37,"90th_percentile":98.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"61","median_amount":286.15,"10th_percentile":286.15,"90th_percentile":890.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"24","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"85","median_amount":110.29,"10th_percentile":109.84,"90th_percentile":220.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":114.21,"10th_percentile":114.21,"90th_percentile":241.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 3 Imaging without Contrast","code_information":[{"code":"5523","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"26","median_amount":911.4,"10th_percentile":474.06,"90th_percentile":2416.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"16","median_amount":256.42,"10th_percentile":254.42,"90th_percentile":347.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"17","median_amount":899.38,"10th_percentile":375.32,"90th_percentile":1766.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":941.93,"10th_percentile":345.84,"90th_percentile":3573.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":709.48,"10th_percentile":635.17,"90th_percentile":1565.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":259.61,"10th_percentile":259.61,"90th_percentile":259.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":250.82,"10th_percentile":250.07,"90th_percentile":252.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":157.71,"10th_percentile":157.71,"90th_percentile":157.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"75","median_amount":267.6,"10th_percentile":267.1,"90th_percentile":1568.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":504.19,"10th_percentile":504.19,"90th_percentile":1008.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":162.31,"10th_percentile":162.31,"90th_percentile":162.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":110.54,"10th_percentile":110.54,"90th_percentile":110.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"22","median_amount":580.78,"10th_percentile":580.78,"90th_percentile":1420.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":168.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":250.68,"10th_percentile":250.68,"90th_percentile":360.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":259.61,"10th_percentile":259.61,"90th_percentile":259.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Imaging without Contrast","code_information":[{"code":"5524","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":3837.98,"10th_percentile":3837.98,"90th_percentile":3837.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":578.62,"10th_percentile":578.62,"90th_percentile":833.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":2113.67,"10th_percentile":1837.14,"90th_percentile":2515.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":2204.77,"10th_percentile":2204.77,"90th_percentile":2204.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":658.16,"10th_percentile":658.16,"90th_percentile":658.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":416.53,"10th_percentile":416.53,"90th_percentile":416.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":606.24,"10th_percentile":605.89,"90th_percentile":2595.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":568.64,"10th_percentile":568.64,"90th_percentile":1459.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":588.9,"10th_percentile":588.9,"90th_percentile":588.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Imaging with Contrast","code_information":[{"code":"5571","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"12","median_amount":782.19,"10th_percentile":564.06,"90th_percentile":2799.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":190.38,"10th_percentile":187.38,"90th_percentile":457.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"12","median_amount":963.2,"10th_percentile":428.14,"90th_percentile":1505.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":728.01,"10th_percentile":245.12,"90th_percentile":1376.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":191.2,"10th_percentile":191.2,"90th_percentile":191.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":184.98,"10th_percentile":184.98,"90th_percentile":184.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":213.11,"10th_percentile":213.11,"90th_percentile":213.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":242.41,"10th_percentile":196.71,"90th_percentile":4418.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":907.59,"10th_percentile":907.59,"90th_percentile":907.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":78.79,"10th_percentile":78.79,"90th_percentile":78.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":655.58,"10th_percentile":650.64,"90th_percentile":1293.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":116.16,"10th_percentile":116.16,"90th_percentile":116.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":184.62,"10th_percentile":184.62,"90th_percentile":451.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":284.36,"10th_percentile":191.2,"90th_percentile":467.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Imaging with Contrast","code_information":[{"code":"5572","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":305.56,"10th_percentile":305.56,"90th_percentile":305.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"24","median_amount":1043.94,"10th_percentile":642.6,"90th_percentile":1841.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"11","median_amount":376.21,"10th_percentile":375.9,"90th_percentile":379.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"20","median_amount":1293.95,"10th_percentile":279.47,"90th_percentile":4620.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":1249.3,"10th_percentile":653.12,"90th_percentile":1982.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":383.57,"10th_percentile":383.57,"90th_percentile":383.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":883.46,"10th_percentile":883.46,"90th_percentile":883.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":263.1,"10th_percentile":263.1,"90th_percentile":263.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":395.14,"10th_percentile":394.64,"90th_percentile":2238.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":744.92,"10th_percentile":744.92,"90th_percentile":744.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":219.31,"10th_percentile":219.31,"90th_percentile":219.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":110.54,"10th_percentile":110.54,"90th_percentile":110.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":960.45,"10th_percentile":674.07,"90th_percentile":1773.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"13","median_amount":112.48,"10th_percentile":56.24,"90th_percentile":168.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":370.38,"10th_percentile":370.38,"90th_percentile":886.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":383.57,"10th_percentile":383.57,"90th_percentile":383.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 2 Nuclear Medicine and Related Services","code_information":[{"code":"5592","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":516.6,"10th_percentile":516.6,"90th_percentile":516.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Nuclear Medicine and Related Services","code_information":[{"code":"5594","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":3368.16,"10th_percentile":3368.16,"90th_percentile":3368.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3804.88,"10th_percentile":1535.26,"90th_percentile":5290.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":2068.07,"10th_percentile":1696.71,"90th_percentile":2288.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":3481.97,"10th_percentile":3481.97,"90th_percentile":13139.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":5398.1,"10th_percentile":5398.1,"90th_percentile":5398.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1511.48,"10th_percentile":1511.48,"90th_percentile":1511.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":934.73,"10th_percentile":934.73,"90th_percentile":934.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":1617.88,"10th_percentile":1611.8,"90th_percentile":7242.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3050.57,"10th_percentile":8.17,"90th_percentile":3050.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":11089.59,"10th_percentile":3772.34,"90th_percentile":13479.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":115.63,"10th_percentile":115.63,"90th_percentile":115.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1512.71,"10th_percentile":1512.71,"90th_percentile":1537.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1570.8,"10th_percentile":1570.8,"90th_percentile":1570.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 1 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5611","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5612","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":432.52,"10th_percentile":432.52,"90th_percentile":432.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Therapeutic Radiation Treatment Preparation","code_information":[{"code":"5613","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":885.62,"10th_percentile":885.62,"90th_percentile":885.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":885.62,"10th_percentile":885.62,"90th_percentile":885.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Radiation Therapy","code_information":[{"code":"5621","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Radiation Therapy","code_information":[{"code":"5622","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Radiation Therapy","code_information":[{"code":"5623","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":310.36,"10th_percentile":310.36,"90th_percentile":310.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":26692.0,"10th_percentile":26692.0,"90th_percentile":26692.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":748.63,"10th_percentile":748.63,"90th_percentile":748.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":1918.63,"10th_percentile":1606.56,"90th_percentile":1918.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":310.36,"10th_percentile":310.36,"90th_percentile":389.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"32","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":970.07,"10th_percentile":970.07,"90th_percentile":970.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 6 Radiation Therapy","code_information":[{"code":"5626","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6723.46,"10th_percentile":6723.46,"90th_percentile":6723.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Pathology","code_information":[{"code":"5671","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":525.65,"10th_percentile":525.65,"90th_percentile":525.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":96.25,"10th_percentile":96.25,"90th_percentile":481.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":42.12,"10th_percentile":42.12,"90th_percentile":42.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Pathology","code_information":[{"code":"5672","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":738.79,"10th_percentile":738.79,"90th_percentile":738.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Pathology","code_information":[{"code":"5673","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":1302.62,"10th_percentile":1302.62,"90th_percentile":1302.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":171.61,"10th_percentile":171.61,"90th_percentile":171.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":415.21,"10th_percentile":415.21,"90th_percentile":415.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":218.57,"10th_percentile":218.57,"90th_percentile":218.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":393.03,"10th_percentile":393.03,"90th_percentile":402.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Drug Administration","code_information":[{"code":"5693","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":221.76,"10th_percentile":221.76,"90th_percentile":221.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":424.92,"10th_percentile":424.92,"90th_percentile":424.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Drug Administration","code_information":[{"code":"5694","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":367.27,"10th_percentile":367.27,"90th_percentile":367.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Diagnostic Tests and Related Services","code_information":[{"code":"5721","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":239.38,"10th_percentile":60.24,"90th_percentile":936.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":166.18,"10th_percentile":166.18,"90th_percentile":166.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":215.99,"10th_percentile":193.46,"90th_percentile":226.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":192.38,"10th_percentile":192.38,"90th_percentile":192.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":225.3,"10th_percentile":225.3,"90th_percentile":225.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":161.7,"10th_percentile":161.7,"90th_percentile":161.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":172.89,"10th_percentile":172.89,"90th_percentile":172.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":226.48,"10th_percentile":226.48,"90th_percentile":226.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 2 Diagnostic Tests and Related Services","code_information":[{"code":"5722","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":964.03,"10th_percentile":964.03,"90th_percentile":964.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":327.77,"10th_percentile":327.77,"90th_percentile":327.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":314.43,"10th_percentile":314.43,"90th_percentile":314.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":957.76,"10th_percentile":957.76,"90th_percentile":957.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":344.61,"10th_percentile":344.11,"90th_percentile":483.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":649.54,"10th_percentile":649.54,"90th_percentile":649.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":322.96,"10th_percentile":322.96,"90th_percentile":322.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Diagnostic Tests and Related Services","code_information":[{"code":"5723","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":204.28,"10th_percentile":204.28,"90th_percentile":204.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":559.99,"10th_percentile":559.99,"90th_percentile":559.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":501.64,"10th_percentile":501.64,"90th_percentile":501.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 4 Diagnostic Tests and Related Services","code_information":[{"code":"5724","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"12","median_amount":498.78,"10th_percentile":498.78,"90th_percentile":1982.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1072.38,"10th_percentile":1072.38,"90th_percentile":1072.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":1684.86,"10th_percentile":1684.86,"90th_percentile":1924.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":1480.0,"10th_percentile":1480.0,"90th_percentile":1674.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":1865.58,"10th_percentile":1865.58,"90th_percentile":3873.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":1092.73,"10th_percentile":1092.73,"90th_percentile":1092.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1051.47,"10th_percentile":1051.47,"90th_percentile":1051.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1748.61,"10th_percentile":1748.61,"90th_percentile":1748.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2122.14,"10th_percentile":2122.14,"90th_percentile":2122.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":506.42,"10th_percentile":506.42,"90th_percentile":506.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":501.64,"10th_percentile":501.64,"90th_percentile":501.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":1875.29,"10th_percentile":1875.29,"90th_percentile":3894.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1055.14,"10th_percentile":1055.14,"90th_percentile":1055.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 3 Minor Procedures","code_information":[{"code":"5733","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":372.18,"10th_percentile":372.18,"90th_percentile":372.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":63.79,"10th_percentile":63.79,"90th_percentile":63.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":292.38,"10th_percentile":292.38,"90th_percentile":314.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":158.11,"10th_percentile":158.11,"90th_percentile":330.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":1125.85,"10th_percentile":1125.85,"90th_percentile":1125.85},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":44.86,"10th_percentile":44.86,"90th_percentile":74.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":352.11,"10th_percentile":352.11,"90th_percentile":352.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":62.6,"10th_percentile":62.6,"90th_percentile":62.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":63.79,"10th_percentile":63.79,"90th_percentile":63.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Level 4 Minor Procedures","code_information":[{"code":"5734","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":187.1,"10th_percentile":187.1,"90th_percentile":187.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":1050.65,"10th_percentile":1050.65,"90th_percentile":1365.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":1623.74,"10th_percentile":1623.74,"90th_percentile":1623.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":142.44,"10th_percentile":142.44,"90th_percentile":338.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":296.69,"10th_percentile":296.69,"90th_percentile":296.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":28.23,"10th_percentile":28.23,"90th_percentile":28.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":598.69,"10th_percentile":598.69,"90th_percentile":598.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":29.42,"10th_percentile":29.42,"90th_percentile":29.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Resuscitation and Cardioversion","code_information":[{"code":"5781","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1499.33,"10th_percentile":1499.33,"90th_percentile":1499.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Treatment","code_information":[{"code":"5791","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-OPPS Clinic Services","code_information":[{"code":"N700","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":300.76,"10th_percentile":300.76,"90th_percentile":300.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":148.76,"10th_percentile":148.76,"90th_percentile":148.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Clinical Diagnostic Lab Services","code_information":[{"code":"N800","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":16.54,"10th_percentile":16.54,"90th_percentile":16.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"283","median_amount":244.33,"10th_percentile":49.94,"90th_percentile":797.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"108","median_amount":59.58,"10th_percentile":18.41,"90th_percentile":127.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"92","median_amount":585.09,"10th_percentile":199.65,"90th_percentile":1320.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":759.86,"10th_percentile":169.99,"90th_percentile":1520.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"87","median_amount":872.07,"10th_percentile":170.59,"90th_percentile":1322.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":93.32,"10th_percentile":27.09,"90th_percentile":224.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":82.17,"10th_percentile":82.17,"90th_percentile":116.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":8.46,"10th_percentile":8.46,"90th_percentile":8.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"178","median_amount":281.76,"10th_percentile":50.15,"90th_percentile":556.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":58.93,"10th_percentile":17.58,"90th_percentile":212.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"1 through 10","median_amount":761.33,"10th_percentile":761.33,"90th_percentile":761.33},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":23.12,"10th_percentile":16.74,"90th_percentile":95.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":45.77,"10th_percentile":45.77,"90th_percentile":45.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"58","median_amount":16.5,"10th_percentile":5.46,"90th_percentile":45.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"91","median_amount":661.0,"10th_percentile":244.22,"90th_percentile":1290.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"43","median_amount":40.97,"10th_percentile":7.35,"90th_percentile":122.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"126","median_amount":76.8,"10th_percentile":26.39,"90th_percentile":173.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":51.06,"10th_percentile":16.65,"90th_percentile":75.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Therapy Services","code_information":[{"code":"N801","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"21","median_amount":39.73,"10th_percentile":26.48,"90th_percentile":62.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":189.89,"10th_percentile":91.01,"90th_percentile":460.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":62.7,"10th_percentile":62.7,"90th_percentile":128.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":179.34,"10th_percentile":147.48,"90th_percentile":787.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":234.06,"10th_percentile":234.06,"90th_percentile":234.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":89.36,"10th_percentile":89.36,"90th_percentile":226.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":34.1,"10th_percentile":34.1,"90th_percentile":184.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":101.64,"10th_percentile":65.83,"90th_percentile":204.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":164.53,"10th_percentile":164.53,"90th_percentile":164.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":217.32,"10th_percentile":217.32,"90th_percentile":217.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":152.8,"10th_percentile":152.8,"90th_percentile":152.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"43","median_amount":34.76,"10th_percentile":23.17,"90th_percentile":164.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":179.65,"10th_percentile":89.83,"90th_percentile":228.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":126.32,"10th_percentile":126.32,"90th_percentile":126.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mammography Services","code_information":[{"code":"N804","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"90","median_amount":68.83,"10th_percentile":68.83,"90th_percentile":289.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"32","median_amount":111.44,"10th_percentile":111.44,"90th_percentile":111.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"1 through 10","median_amount":244.48,"10th_percentile":244.48,"90th_percentile":244.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"61","median_amount":84.53,"10th_percentile":76.39,"90th_percentile":90.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"1 through 10","median_amount":90.02,"10th_percentile":90.02,"90th_percentile":90.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"45","median_amount":257.45,"10th_percentile":257.45,"90th_percentile":257.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"1 through 10","median_amount":113.72,"10th_percentile":113.72,"90th_percentile":124.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.94,"10th_percentile":119.94,"90th_percentile":119.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"119","median_amount":117.0,"10th_percentile":116.21,"90th_percentile":117.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":220.85,"10th_percentile":220.85,"90th_percentile":220.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":46.23,"10th_percentile":46.23,"90th_percentile":46.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"39","median_amount":317.7,"10th_percentile":317.7,"90th_percentile":317.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"12","median_amount":56.24,"10th_percentile":56.24,"90th_percentile":56.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":109.36,"10th_percentile":109.36,"90th_percentile":111.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":113.72,"10th_percentile":113.72,"90th_percentile":113.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."}]}]},{"description":"Non-covered Services","code_information":[{"code":"N900","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"1 through 10","median_amount":147.12,"10th_percentile":104.29,"90th_percentile":425.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":146.16,"10th_percentile":146.16,"90th_percentile":180.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":550.26,"10th_percentile":390.08,"90th_percentile":550.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":607.83,"10th_percentile":607.83,"90th_percentile":607.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Not Recognized by OPPS","code_information":[{"code":"N905","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Better Health Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 61.2] [Cardiac Cath (%BC): 61.2] [Observation (%BC): 65.8] [Emergency Department (%BC): 65.8] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory (%BC): 61.2] [Occupational Therapy (%BC): 61.2] [Physical Therapy (%BC): 61.2] [Respiratory Services/Therapy  (%BC): 61.2] [Speech Therapy (%BC): 61.2] [All Other OP (%BC): 61.2]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP ECT Mental Health ($): 950] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Avmed","plan_name":"Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 54.7] [Observation (%BC): 69] [Emergency Department (%BC): 69] [Occupational Therapy (%BC): 54.7] [Physical Therapy (%BC): 54.7] [Respiratory Services/Therapy  (%BC): 54.7] [Speech Therapy (%BC): 54.7] [All Other OP (%BC): 54.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 55.22] [Cardiac Cath (%BC): 55.22] [Lithotripsy (%BC): 55.22] [PTCA (%BC): 55.22] [Observation (%BC): 55.22] [Emergency Department (%BC): 55.22] [Other Cardiac Testing (%BC): 55.22] [EEG (%BC): 55.22] [Chemotherapy (%BC): 55.22] [Nuclear Medicine (%BC): 17.09] [Radiation Therapy  (%BC): 55.22] [CT OP Scan (%BC): 17.09] [MRI OP (%BC): 17.09] [Positron Emission Tomography (%BC): 17.09] [Radiology (%BC): 17.09] [Laboratory (%BC): 55.22] [Occupational Therapy (%BC): 55.22] [Physical Therapy (%BC): 55.22] [Respiratory Services/Therapy  (%BC): 55.22] [Speech Therapy (%BC): 55.22] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 55.22] [All Other OP (%BC): 55.22]","count":"1 through 10","median_amount":179.52,"10th_percentile":179.52,"90th_percentile":243.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Bcbs","plan_name":"Ppc Ppo","methodology":"other","standard_charge_algorithm":"[OP Surgery  (%BC): 49.86] [Cardiac Cath (%BC): 49.86] [Lithotripsy (%BC): 49.86] [PTCA (%BC): 49.86] [Observation (%BC): 62.59] [Emergency Department (%BC): 62.59] [Other Cardiac Testing (%BC): 59.41] [EEG (%BC): 59.41] [Chemotherapy (%BC): 59.41] [Nuclear Medicine (%BC): 20.14] [Radiation Therapy  (%BC): 59.41] [CT OP Scan (%BC): 20.14] [MRI OP (%BC): 20.14] [Positron Emission Tomography (%BC): 20.14] [Radiology (%BC): 20.14] [Laboratory (%BC): 59.41] [Occupational Therapy (%BC): 59.41] [Physical Therapy (%BC): 59.41] [Respiratory Services/Therapy  (%BC): 59.41] [Speech Therapy (%BC): 59.41] [Other Outpatient Implant (%BC): 29.38] [IV Therapy (%BC): 59.41] [All Other OP (%BC): 59.41]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.6] [Cardiac Cath (%BC): 57.6] [Observation (%BC): 62.8] [Emergency Department (%BC): 62.8] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.6] [Physical Therapy (%BC): 57.6] [Respiratory Services/Therapy  (%BC): 57.6] [Speech Therapy (%BC): 57.6] [All Other OP (%BC): 57.6]","count":"1 through 10","median_amount":62.93,"10th_percentile":62.93,"90th_percentile":62.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] [All Other OP (%BC): 50]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery  (%BC): 57.9] [Observation (%BC): 53.8] [Emergency Department (%BC): 53.8] [Radiology (%BC): 50] [Radiology Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 57.9] [Physical Therapy (%BC): 57.9] [Respiratory Services/Therapy  (%BC): 57.9] [Speech Therapy (%BC): 57.9] [All Other OP (%BC): 57.9]","count":"1 through 10","median_amount":819.34,"10th_percentile":795.76,"90th_percentile":819.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bone marrow transplant","code_information":[{"code":"009","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hyphema","code_information":[{"code":"043","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"109","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & stripping","code_information":[{"code":"119","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Deep Vein Thrombophlebitis","code_information":[{"code":"128","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W Cc/Mcc Or Major Device","code_information":[{"code":"129","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures W/O Cc/Mcc","code_information":[{"code":"130","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W Cc/Mcc","code_information":[{"code":"131","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures w/o CC","code_information":[{"code":"171","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"G.I. hemorrhage w CC","code_information":[{"code":"174","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w CC","code_information":[{"code":"210","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip & Femur Procedures Except Major Joint Age >17 w/o CC","code_information":[{"code":"211","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"214","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/o MCC","code_information":[{"code":"238","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Laparoscopy & Incisional Tubal Interruption","code_information":[{"code":"361","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & Radio-Implant, for Malignancy","code_information":[{"code":"363","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization Except for Malignancy","code_information":[{"code":"364","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures","code_information":[{"code":"365","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"400","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Poisoning & toxic Effects of Drugs Age >17 w CC","code_information":[{"code":"449","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/o CC/MCC","code_information":[{"code":"491","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alc/Drug Abuse or Depend w/o Rehabilitation therapy w/o CC","code_information":[{"code":"523","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","code_information":[{"code":"524","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other heart assist system implant","code_information":[{"code":"525","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"527","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Proc w Pdx Hemorrhage","code_information":[{"code":"528","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular shunt procedures w CC","code_information":[{"code":"529","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures w/o CC","code_information":[{"code":"530","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Procedures Proc Age > 17 w CC w/o Major Gi Dx","code_information":[{"code":"568","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W Cc/Mcc","code_information":[{"code":"691","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urinary Stones W Esw Lithotripsy W/O Cc/Mcc","code_information":[{"code":"692","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W Cc/Mcc","code_information":[{"code":"765","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cesarean Section W/O Cc/Mcc","code_information":[{"code":"766","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Sterilization &/Or D&C","code_information":[{"code":"767","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/O Complicating Diagnoses","code_information":[{"code":"775","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ectopic Pregnancy","code_information":[{"code":"777","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Threatened Abortion","code_information":[{"code":"778","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"False Labor","code_information":[{"code":"780","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W Medical Complications","code_information":[{"code":"781","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Mcc","code_information":[{"code":"984","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W Cc","code_information":[{"code":"985","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prostatic O.R. Procedure Unrelated To Principal Diagnosis W/O Cc/Mcc","code_information":[{"code":"986","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 145379 | Total % of Charge: 42.6] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 15082 Days: 3 Additional Days: 2012] [Normal vag. Del. 2 day stay-Case Rate: 10894 Days: 2 Additional Days: 2012] [Nursery  Level 1- Boarder-Per Diem: 1174] [Nursery  Level 2-Per Diem: 2263] [Nursery  Level 3-Per Diem: 4946] [Nursery  Level 4-NICU-Per Diem: 5698] [Psych-Per Diem: 1633] [SNF-Per Diem: 1337] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 10000 (%BC): 36.3]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 1050]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Bcbs","plan_name":"Healthoptions Hmo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 186851 | Total % of Charge: 56.57] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [SNF-Per Diem: 1078] [IP Prosthetics/Implants/Devices (%BC): 29.38]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Carelon","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1203] [Psych-Per Diem: 1203]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 131648 | Total % of Charge: 48.3] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 3 day stay-Case Rate: 16019 Days: 3 Additional Days: 1922] [Normal vag. Del. 2 day stay-Case Rate: 12015 Days: 2 Additional Days: 1922] [Nursery  Level 1- Boarder-Per Diem: 1202] [Nursery  Level 2-Per Diem: 1922] [Nursery  Level 3-Per Diem: 4006] [Nursery  Level 4-NICU-Per Diem: 4808] [SNF-Per Diem: 925] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13595 (%BC): 25.7]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"1 through 10","median_amount":6122.03,"10th_percentile":6122.03,"90th_percentile":6122.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer’s algorithm."},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Private Healthcare Systems, Inc.","plan_name":"Ppo","methodology":"percent of total billed charges","standard_charge_percentage":65.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Sunshine Health","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 169510 | Total % of Charge: 56.9] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section 4 day stay-Case Rate: 14912 Days: 4 Additional Days: 2132] [Normal vag. Del. 2 day stay-Case Rate: 11292 Days: 2 Additional Days: 2132] [Nursery  Level 1- Boarder-Per Diem: 1131] [Nursery  Level 2-Per Diem: 2033] [Nursery  Level 3-Per Diem: 4819] [Nursery  Level 4-NICU-Per Diem: 5044] [Rehab-Per Diem: 1758] [SNF-Per Diem: 958] [Hospice-Per Diem: 711] [IP Prosthetics/Implants/Devices ($): 0 Charge Threshold 13843 (%BC): 32.5]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://ahca.myflorida.com/medicaid/]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Behavioral Health","methodology":"other","standard_charge_algorithm":"[Alcohol/ Chemical Dependency-Per Diem: 1038] [Psych-Per Diem: 1038]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE] [Psych-Per Diem: 981.53]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rem mlt day uroflow setup","code_information":[{"code":"0811T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr impl ivc snr set-up","code_information":[{"code":"0982T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr s-scl eeg sys setup","code_information":[{"code":"1008T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam new patient","code_information":[{"code":"92004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam establish patient","code_information":[{"code":"92012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam&tx estab pt 1/>vst","code_information":[{"code":"92014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Glucose monitoring cont","code_information":[{"code":"95250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Rem ther mntr 1st setup&edu","code_information":[{"code":"98975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Rem mntr physiol param setup","code_information":[{"code":"99453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Init nb em per day hosp","code_information":[{"code":"99460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Same day nb discharge","code_information":[{"code":"99463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 14 day disch","code_information":[{"code":"99495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Trans care mgmt 7 day disch","code_information":[{"code":"99496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Periodic oral evaluation","code_information":[{"code":"D0120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Limit oral eval problm focus","code_information":[{"code":"D0140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensve oral evaluation","code_information":[{"code":"D0150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Extensv oral eval prob focus","code_information":[{"code":"D0160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Re-eval,est pt,problem focus","code_information":[{"code":"D0170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Re-eval post-op visit","code_information":[{"code":"D0171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Comp periodontal evaluation","code_information":[{"code":"D0180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Assessment of a patient","code_information":[{"code":"D0191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Dental prophylaxis adult","code_information":[{"code":"D1110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Gingival irrigation per quad","code_information":[{"code":"D4921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Initial foot exam pt lops","code_information":[{"code":"G0245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Followup eval of foot pt lop","code_information":[{"code":"G0246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Demonstrate use home inr mon","code_information":[{"code":"G0248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Provide INR test mater/equip","code_information":[{"code":"G0249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Initial preventive exam","code_information":[{"code":"G0402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Hospital outpt clinic visit","code_information":[{"code":"G0463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Supply of digital device","code_information":[{"code":"G0552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Monthly tx for dmht 20mins","code_information":[{"code":"G0553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":132.08,"maximum":277.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.98,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.65,"maximum":175.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":175.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92.46,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":152.33,"maximum":319.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":160.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":319.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":168.36,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.81,"maximum":568.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":305.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":296.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":316.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":568.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.32,"additional_payer_notes":"APC"}]}]},{"description":"Dialysis one evaluation","code_information":[{"code":"90945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":413.95,"maximum":868.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":466.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":448.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":435.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":453.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":484.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":868.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":461.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":457.53,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":413.95,"maximum":868.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":466.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":448.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":435.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":453.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":484.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":868.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":461.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":457.53,"additional_payer_notes":"APC"}]}]},{"description":"Opps service,sched team conf","code_information":[{"code":"G0175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":413.95,"maximum":868.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":466.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":448.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":435.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":453.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":484.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":868.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":461.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":457.53,"additional_payer_notes":"APC"}]}]},{"description":"Emergency dept visit","code_information":[{"code":"99285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":590.81,"maximum":1240.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":665.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":640.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":590.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":646.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":691.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1240.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":659.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":653.0,"additional_payer_notes":"APC"}]}]},{"description":"Direct refer hospital observ","code_information":[{"code":"G0379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":590.81,"maximum":1240.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":665.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":640.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":590.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":646.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":691.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1240.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":659.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":653.0,"additional_payer_notes":"APC"}]}]},{"description":"Critical care first hour","code_information":[{"code":"99291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":819.47,"maximum":1720.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":922.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":862.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":959.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1720.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":914.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.73,"additional_payer_notes":"APC"}]}]},{"description":"Slctv nzmtc dbrdmt t/a/l 1st","code_information":[{"code":"0973T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Slctv nzmtc dbrdmt s/n/hf 1","code_information":[{"code":"0975T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Fna w/o image","code_information":[{"code":"10021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of skin abscess","code_information":[{"code":"10061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body","code_information":[{"code":"10120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Puncture drainage of lesion","code_information":[{"code":"10160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Debride infected skin","code_information":[{"code":"11000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Deb subq tissue 20 sq cm/<","code_information":[{"code":"11042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Tangntl bx skin single les","code_information":[{"code":"11102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Punch bx skin single lesion","code_information":[{"code":"11104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 0.5 cm/<","code_information":[{"code":"11300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion 1.1-2.0 cm","code_information":[{"code":"11312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Shave skin lesion >2.0 cm","code_information":[{"code":"11313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 0.6-1 cm","code_information":[{"code":"11401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 1.1-2 cm","code_information":[{"code":"11602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Removal of nail bed","code_information":[{"code":"11750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Excision of nail fold toe","code_information":[{"code":"11765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/a/gen/trk12.6-20.0cm","code_information":[{"code":"12005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Rpr s/n/a/gen/trk20.1-30.0cm","code_information":[{"code":"12006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fe/e/en/l/m 12.6-20.0 cm","code_information":[{"code":"12016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fe/e/en/l/m 20.1-30.0 cm","code_information":[{"code":"12017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Closure of split wound","code_information":[{"code":"12021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 2.5 cm/<","code_information":[{"code":"12031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 2.6-7.5","code_information":[{"code":"12032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/tr/ext 7.6-12.5","code_information":[{"code":"12034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr s/a/t/ext 12.6-20","code_information":[{"code":"12035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit 2.5cm/<","code_information":[{"code":"12041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr n-hf/genit2.6-7.5","code_information":[{"code":"12042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 2.5 cm/<","code_information":[{"code":"12051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 2.6-5.0 cm","code_information":[{"code":"12052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 5.1-7.5 cm","code_information":[{"code":"12053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 7.6-12.5cm","code_information":[{"code":"12054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 12.6-20 cm","code_information":[{"code":"12055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm 20.1-30.0","code_information":[{"code":"12056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Intmd rpr face/mm >30.0 cm","code_information":[{"code":"12057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr s/a/l 1.1-2.5 cm","code_information":[{"code":"13120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr s/a/l 2.6-7.5 cm","code_information":[{"code":"13121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Cmplx rpr f/c/c/m/n/ax/g/h/f","code_information":[{"code":"13132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Wound prep f/n/hf/g","code_information":[{"code":"15004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Hair trnspl 1-15 punch grfts","code_information":[{"code":"15775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Hair trnspl >15 punch grafts","code_information":[{"code":"15776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion suprfl any site","code_information":[{"code":"15783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel face epiderm","code_information":[{"code":"15788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Chemical peel nonfacial","code_information":[{"code":"15793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Dress/debrid p-thick burn l","code_information":[{"code":"16030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Incision of burn scab initi","code_information":[{"code":"16035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destroy premal lesions 15/>","code_information":[{"code":"17004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction of skin lesions","code_information":[{"code":"17283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Injection(s) spider veins","code_information":[{"code":"36468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Injection therapy of vein","code_information":[{"code":"36470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Injection therapy of veins","code_information":[{"code":"36471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Destruction penis lesion(s)","code_information":[{"code":"54050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy uv-a or b","code_information":[{"code":"96913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Laser tx skin >500 sq cm","code_information":[{"code":"96922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wnd tx <=50 sq cm","code_information":[{"code":"97607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Neg press wound tx >50 cm","code_information":[{"code":"97608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":403.29,"maximum":846.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":454.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":437.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":472.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":846.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.74,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/us gdn 1st les","code_information":[{"code":"10005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/fluor gdn 1st les","code_information":[{"code":"10007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/ct gdn 1st les","code_information":[{"code":"10009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Fna bx w/mr gdn 1st les","code_information":[{"code":"10011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Guide cathet fluid drainage","code_information":[{"code":"10030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev soft tiss 1st imag","code_information":[{"code":"10035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pilonidal cyst","code_information":[{"code":"10081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Debride skin at fx site","code_information":[{"code":"11010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Debride skin musc at fx site","code_information":[{"code":"11011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 0.5 cm<","code_information":[{"code":"11400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 1.1-2 cm","code_information":[{"code":"11402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 2.1-3cm/<","code_information":[{"code":"11403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.6-1","code_information":[{"code":"11421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 0.5 cm/<","code_information":[{"code":"11440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 0.6-1 cm","code_information":[{"code":"11441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 1.1-2 cm","code_information":[{"code":"11442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 0.5 cm/<","code_information":[{"code":"11600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 0.6-1 cm","code_information":[{"code":"11601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 2.1-3 cm","code_information":[{"code":"11603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg 3.1-4 cm","code_information":[{"code":"11604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 0.6-1","code_information":[{"code":"11621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 1.1-2","code_information":[{"code":"11622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.5cm<","code_information":[{"code":"11640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 0.6-1","code_information":[{"code":"11641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 1.1-2","code_information":[{"code":"11642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy nail unit","code_information":[{"code":"11755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Remove contraceptive capsule","code_information":[{"code":"11976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion segmental face","code_information":[{"code":"15781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal of pressure sore","code_information":[{"code":"15999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of breast lesion","code_information":[{"code":"19000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st strtctc","code_information":[{"code":"19283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st us imag","code_information":[{"code":"19285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Perq dev breast 1st mr guide","code_information":[{"code":"19287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of bone cyst","code_information":[{"code":"20615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Fluid pressure muscle","code_information":[{"code":"20950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl subq car rhythm mntr","code_information":[{"code":"33286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of mouth lesion","code_information":[{"code":"40800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of salivary gland","code_information":[{"code":"42400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Liver surgery procedure","code_information":[{"code":"47399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Pancreas surgery procedure","code_information":[{"code":"48999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of kidney lesion","code_information":[{"code":"50390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hydrocele","code_information":[{"code":"55000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of thyroid","code_information":[{"code":"60100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Aspir/inj thyroid cyst","code_information":[{"code":"60300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Interdiscal perq aspir dx","code_information":[{"code":"62267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Drain outer ear canal lesion","code_information":[{"code":"69020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"I&d absc intraoral soft tiss","code_information":[{"code":"D7510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Incision/drain abscess intra","code_information":[{"code":"D7511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"I&d abscess extraoral","code_information":[{"code":"D7520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Incision/drain abscess extra","code_information":[{"code":"D7521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":702.51,"maximum":1474.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":791.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":739.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":822.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1474.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":783.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":776.46,"additional_payer_notes":"APC"}]}]},{"description":"Abltj b9 thyr ndul perq lasr","code_information":[{"code":"0673T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Rmv/rplc magnet coil assem","code_information":[{"code":"0959T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body","code_information":[{"code":"10121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hematoma/fluid","code_information":[{"code":"10140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Deb bone 20 sq cm/<","code_information":[{"code":"11044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg 3.1-4 cm","code_information":[{"code":"11404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext b9+marg >4.0 cm","code_information":[{"code":"11406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 0.5/<","code_information":[{"code":"11420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 1.1-2","code_information":[{"code":"11422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 2.1-3","code_information":[{"code":"11423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg 3.1-4","code_information":[{"code":"11424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 2.1-3 cm","code_information":[{"code":"11443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg 3.1-4 cm","code_information":[{"code":"11444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc tr-ext mal+marg >4 cm","code_information":[{"code":"11606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp mal+marg 0.5/<","code_information":[{"code":"11620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 2.1-3","code_information":[{"code":"11623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg 3.1-4","code_information":[{"code":"11624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 2.1-3","code_information":[{"code":"11643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg 3.1-4","code_information":[{"code":"11644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Incision of breast lesion","code_information":[{"code":"19020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion strtctc","code_information":[{"code":"19081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion us imag","code_information":[{"code":"19083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast 1st lesion mr imag","code_information":[{"code":"19085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Bx breast percut w/o image","code_information":[{"code":"19100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Perq device breast 1st imag","code_information":[{"code":"19281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Explore wound extremity","code_information":[{"code":"20103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Muscle biopsy","code_information":[{"code":"20200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy muscle","code_information":[{"code":"20206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy trocar/needle","code_information":[{"code":"20225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of support implant","code_information":[{"code":"20670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc face les sc <2 cm","code_information":[{"code":"21011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc face les sbq 2 cm/>","code_information":[{"code":"21012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc face tum deep < 2 cm","code_information":[{"code":"21013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of neck/chest","code_information":[{"code":"21550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck les sc < 3 cm","code_information":[{"code":"21555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy soft tissue of back","code_information":[{"code":"21925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc back les sc < 3 cm","code_information":[{"code":"21930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc back les sc 3 cm/>","code_information":[{"code":"21931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc abd les sc < 3 cm","code_information":[{"code":"22902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder les sc 3 cm/>","code_information":[{"code":"23071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder les sc < 3 cm","code_information":[{"code":"23075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder foreign body","code_information":[{"code":"23330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of arm bursa","code_information":[{"code":"23931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc arm/elbow les sc < 3 cm","code_information":[{"code":"24075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm les sc 3 cm/>","code_information":[{"code":"25071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm les sc < 3 cm","code_information":[{"code":"25075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm tum deep < 3 cm","code_information":[{"code":"25076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of finger abscess","code_information":[{"code":"26011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand les sc 1.5 cm/>","code_information":[{"code":"26111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand tum deep 1.5 cm/>","code_information":[{"code":"26113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand les sc < 1.5 cm","code_information":[{"code":"26115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc hand tum deep < 1.5 cm","code_information":[{"code":"26116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of implant from hand","code_information":[{"code":"26320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of soft tissues","code_information":[{"code":"27041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee les sc < 3 cm","code_information":[{"code":"27327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum < 3 cm","code_information":[{"code":"27618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bursa of foot","code_information":[{"code":"28001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum sc < 1.5 cm","code_information":[{"code":"28043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot foreign body","code_information":[{"code":"28193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy chest lining","code_information":[{"code":"32400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Core ndl bx lng/med perq","code_information":[{"code":"32408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Temporal artery procedure","code_information":[{"code":"37609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow aspiration","code_information":[{"code":"38220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Bone marrow biopsy","code_information":[{"code":"38221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy lymph nodes","code_information":[{"code":"38505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of floor of mouth","code_information":[{"code":"41108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy of liver","code_information":[{"code":"47000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy pancreas","code_information":[{"code":"48102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy abdominal mass","code_information":[{"code":"49180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Sclerotx fluid collection","code_information":[{"code":"49185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid colxn visc","code_information":[{"code":"49405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid peri/retro","code_information":[{"code":"49406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Image cath fluid trns/vgnl","code_information":[{"code":"49407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Renal biopsy perq","code_information":[{"code":"50200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Drain penis lesion","code_information":[{"code":"54015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of epididymis","code_information":[{"code":"54800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of scrotum abscess","code_information":[{"code":"55100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Abltj 1/+thyr ndul 1lobe prq","code_information":[{"code":"60660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Needle biopsy spinal cord","code_information":[{"code":"62269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Drain external ear lesion","code_information":[{"code":"69005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1638.49,"maximum":3439.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1845.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1776.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1638.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1724.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1793.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1917.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3439.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1810.96,"additional_payer_notes":"APC"}]}]},{"description":"Complex drainage wound","code_information":[{"code":"10180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Deb skin bone at fx site","code_information":[{"code":"11012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc h-f-nk-sp b9+marg >4 cm","code_information":[{"code":"11426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc face-mm b9+marg >4 cm","code_information":[{"code":"11446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal sweat gland lesion","code_information":[{"code":"11471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc s/n/h/f/g mal+mrg >4 cm","code_information":[{"code":"11626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc f/e/e/n/l mal+mrg >4 cm","code_information":[{"code":"11646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst simple","code_information":[{"code":"11770","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst exten","code_information":[{"code":"11771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove pilonidal cyst compl","code_information":[{"code":"11772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove tissue expander(s)","code_information":[{"code":"11971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion total face","code_information":[{"code":"15780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Dermabrasion other than face","code_information":[{"code":"15782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin thigh","code_information":[{"code":"15832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin leg","code_information":[{"code":"15833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin hip","code_information":[{"code":"15834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin buttck","code_information":[{"code":"15835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Excise excessive skin arm","code_information":[{"code":"15836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin arm/hand","code_information":[{"code":"15837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin fat pad","code_information":[{"code":"15838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Excise excess skin & tissue","code_information":[{"code":"15839","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone ulcer","code_information":[{"code":"15920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove sacrum pressure sore","code_information":[{"code":"15933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip pressure sore","code_information":[{"code":"15941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove thigh pressure sore","code_information":[{"code":"15951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Deep muscle biopsy","code_information":[{"code":"20205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy open superficial","code_information":[{"code":"20240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Bone biopsy open deep","code_information":[{"code":"20245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"20525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal of support implant","code_information":[{"code":"20680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc face tum deep 2 cm/>","code_information":[{"code":"21014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect face/scalp tum < 2 cm","code_information":[{"code":"21015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect face/scalp tum 2 cm/>","code_information":[{"code":"21016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drain neck/chest lesion","code_information":[{"code":"21501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck les sc 3 cm/>","code_information":[{"code":"21552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck tum deep 5 cm/>","code_information":[{"code":"21554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc neck tum deep < 5 cm","code_information":[{"code":"21556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect neck thorax tumor<5cm","code_information":[{"code":"21557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect neck tumor 5 cm/>","code_information":[{"code":"21558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc chest wall tumor w/ribs","code_information":[{"code":"21601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc back tum deep < 5 cm","code_information":[{"code":"21932","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc back tum deep 5 cm/>","code_information":[{"code":"21933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect back tum < 5 cm","code_information":[{"code":"21935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect back tum 5 cm/>","code_information":[{"code":"21936","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc abdl tum deep < 5 cm","code_information":[{"code":"22900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc abdl tum deep 5 cm/>","code_information":[{"code":"22901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc abd les sc 3 cm/>","code_information":[{"code":"22903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Radical resect abd tumor<5cm","code_information":[{"code":"22904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect abd tumor 5 cm/>","code_information":[{"code":"22905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal of calcium deposits","code_information":[{"code":"23000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder lesion","code_information":[{"code":"23030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder bursa","code_information":[{"code":"23031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy shoulder tissues","code_information":[{"code":"23066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder tum deep 5 cm/>","code_information":[{"code":"23073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc shoulder tum deep < 5 cm","code_information":[{"code":"23076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect shoulder tumor < 5 cm","code_information":[{"code":"23077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect shoulder tumor 5 cm/>","code_information":[{"code":"23078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder fb deep","code_information":[{"code":"23333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of arm lesion","code_information":[{"code":"23930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy arm/elbow soft tissue","code_information":[{"code":"24066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc arm/elbow les sc 3 cm/>","code_information":[{"code":"24071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Ex arm/elbow tum deep 5 cm/>","code_information":[{"code":"24073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Ex arm/elbow tum deep < 5 cm","code_information":[{"code":"24076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect arm/elbow tum < 5 cm","code_information":[{"code":"24077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect arm/elbow tum 5 cm/>","code_information":[{"code":"24079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm foreign body","code_information":[{"code":"24201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy forearm soft tissues","code_information":[{"code":"25066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc forearm tum deep 3 cm/>","code_information":[{"code":"25073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect forearm/wrist tum<3cm","code_information":[{"code":"25077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect forarm/wrist tum 3cm>","code_information":[{"code":"25078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect hand tumor < 3 cm","code_information":[{"code":"26117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Rad resect hand tumor 3 cm/>","code_information":[{"code":"26118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip pelvis les sc 3 cm/>","code_information":[{"code":"27043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelv tum deep 5 cm/>","code_information":[{"code":"27045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelvis les sc < 3 cm","code_information":[{"code":"27047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc hip/pelv tum deep < 5 cm","code_information":[{"code":"27048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip/pelv tum < 5 cm","code_information":[{"code":"27049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip/pelv tum 5 cm/>","code_information":[{"code":"27059","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drain thigh/knee lesion","code_information":[{"code":"27301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy thigh soft tissues","code_information":[{"code":"27324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee tum deep <5cm","code_information":[{"code":"27328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect thigh/knee tum < 5 cm","code_information":[{"code":"27329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee les sc 3 cm/>","code_information":[{"code":"27337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc thigh/knee tum dep 5cm/>","code_information":[{"code":"27339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect thigh/knee tum 5 cm/>","code_information":[{"code":"27364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foreign body","code_information":[{"code":"27372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drain lower leg lesion","code_information":[{"code":"27603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy lower leg soft tissue","code_information":[{"code":"27614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect leg/ankle tum < 5 cm","code_information":[{"code":"27615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect leg/ankle tum 5 cm/>","code_information":[{"code":"27616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum deep <5 cm","code_information":[{"code":"27619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle les sc 3 cm/>","code_information":[{"code":"27632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc leg/ankle tum dep 5 cm/>","code_information":[{"code":"27634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum sc 1.5 cm/>","code_information":[{"code":"28039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum dep 1.5cm/>","code_information":[{"code":"28041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Exc foot/toe tum deep <1.5cm","code_information":[{"code":"28045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect foot/toe tumor < 3 cm","code_information":[{"code":"28046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Resect foot/toe tumor 3 cm/>","code_information":[{"code":"28047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Dx bone marrow bx & aspir","code_information":[{"code":"38222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drainage lymph node lesion","code_information":[{"code":"38305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bladder abscess","code_information":[{"code":"51080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of penis","code_information":[{"code":"54105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of testis","code_information":[{"code":"54500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"I & d vaginal hematoma pp","code_information":[{"code":"57022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"I & d vag hematoma non-ob","code_information":[{"code":"57023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove external ear partial","code_information":[{"code":"69110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Remove ear canal lesion(s)","code_information":[{"code":"69145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2881.67,"maximum":6049.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3245.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2881.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3154.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6049.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.0,"additional_payer_notes":"APC"}]}]},{"description":"Abltj mal brst tum perq crtx","code_information":[{"code":"0581T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Ablt b9 brst tum perq lsr ea","code_information":[{"code":"0970T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Ablt mal brst tum pq lsr uni","code_information":[{"code":"0971T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of breast open","code_information":[{"code":"19101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Cryosurg ablate fa each","code_information":[{"code":"19105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Nipple exploration","code_information":[{"code":"19110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Excise breast duct fistula","code_information":[{"code":"19112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast lesion","code_information":[{"code":"19120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Excision breast lesion","code_information":[{"code":"19125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Removal of Breast Tissue","code_information":[{"code":"19300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Partial Mastectomy","code_information":[{"code":"19301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast implant","code_information":[{"code":"19328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Removal of implant material","code_information":[{"code":"19330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Breast reconstruction","code_information":[{"code":"19350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Correct inverted nipple(s)","code_information":[{"code":"19355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Surgery of breast capsule","code_information":[{"code":"19370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Removal of breast capsule","code_information":[{"code":"19371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Design custom breast implant","code_information":[{"code":"19396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Breast surgery procedure","code_information":[{"code":"19499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Incision of lymph channels","code_information":[{"code":"38308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy/removal lymph nodes","code_information":[{"code":"38530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Open bx/exc inguinofem nodes","code_information":[{"code":"38531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Removal neck/armpit lesion","code_information":[{"code":"38550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3884.37,"maximum":8154.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4375.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4211.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3884.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4088.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4252.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4546.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8154.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4334.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4293.25,"additional_payer_notes":"APC"}]}]},{"description":"Rev s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0957T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Apply rem fixation device","code_information":[{"code":"20660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Application of head brace","code_information":[{"code":"20661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Application of pelvis brace","code_information":[{"code":"20662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Application of halo","code_information":[{"code":"20664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove bone fixation device","code_information":[{"code":"20694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Comp ext fixate strut change","code_information":[{"code":"20697","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Replantation digit complete","code_information":[{"code":"20822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Replantation thumb complete","code_information":[{"code":"20827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Manipulation of spine","code_information":[{"code":"22505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Drain shoulder bone lesion","code_information":[{"code":"23035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder blade fx","code_information":[{"code":"23575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of shoulder","code_information":[{"code":"23700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate elbow w/anesth","code_information":[{"code":"24300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tendon sheath","code_information":[{"code":"25000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of forearm bursa","code_information":[{"code":"25031","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist tendon lesion","code_information":[{"code":"25111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Reremove wrist tendon lesion","code_information":[{"code":"25112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Excise wrist tendon sheath","code_information":[{"code":"25118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove forearm foreign body","code_information":[{"code":"25248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate wrist w/anesthes","code_information":[{"code":"25259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand bone lesion","code_information":[{"code":"26034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incise finger tendon sheath","code_information":[{"code":"26055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat hand joint","code_information":[{"code":"26070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Tendon excision palm/finger","code_information":[{"code":"26145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove tendon sheath lesion","code_information":[{"code":"26160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of palm tendon each","code_information":[{"code":"26170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of finger tendon","code_information":[{"code":"26180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove finger bone","code_information":[{"code":"26185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove hand bone lesion","code_information":[{"code":"26200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of finger lesion","code_information":[{"code":"26210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal finger bone","code_information":[{"code":"26236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Resect distal finger tumor","code_information":[{"code":"26262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Manipulate finger w/anesth","code_information":[{"code":"26340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand tendon","code_information":[{"code":"26410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Release palm/finger tendon","code_information":[{"code":"26440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of finger tendon","code_information":[{"code":"26455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incise hand/finger tendon","code_information":[{"code":"26460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Release finger contracture","code_information":[{"code":"26525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger deformity","code_information":[{"code":"26590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvis bursa","code_information":[{"code":"26991","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of sacroiliac joint","code_information":[{"code":"27050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of hip joint","code_information":[{"code":"27052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Buttock fasciotomy w/dbrdmt","code_information":[{"code":"27057","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Cltx thigh fx w/mnpj","code_information":[{"code":"27268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Manipulation of hip joint","code_information":[{"code":"27275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of knee joint","code_information":[{"code":"27570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27752","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Cltx med ankle fx w/mnpj","code_information":[{"code":"27762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Cltx post ankle fx w/mnpj","code_information":[{"code":"27768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendons","code_information":[{"code":"28011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of toe joint","code_information":[{"code":"28024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28092","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe lesions","code_information":[{"code":"28108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Resect phalanx of toe tumor","code_information":[{"code":"28175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot tendon(s)","code_information":[{"code":"28230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of toe tendon","code_information":[{"code":"28232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot tendon","code_information":[{"code":"28234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Release of toe joint each","code_information":[{"code":"28272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair webbed toe(s)","code_information":[{"code":"28345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Hi enrgy eswt plantar fascia","code_information":[{"code":"28890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Wrist endoscopy/surgery","code_information":[{"code":"29848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1595.23,"maximum":3348.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1796.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1729.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1595.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1679.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1746.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3348.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1779.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1763.15,"additional_payer_notes":"APC"}]}]},{"description":"Extracorp shockwv tx anesth","code_information":[{"code":"0102T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl sinus tarsi implant","code_information":[{"code":"0510T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl sbchdrl dfct","code_information":[{"code":"0707T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Njx b1 sub mtrl hw fixj aug","code_information":[{"code":"0869T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Rmv s-sclp eltr ra rcvr&tlmt","code_information":[{"code":"0958T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Excise epiphyseal bar","code_information":[{"code":"20150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Place ndl musc/tis for rt","code_information":[{"code":"20555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Insert and remove bone pin","code_information":[{"code":"20650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Application of thigh brace","code_information":[{"code":"20663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Open tx septal fx w/wo stabj","code_information":[{"code":"21336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drain chest lesion","code_information":[{"code":"21502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"21510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of sternum","code_information":[{"code":"21620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Sternal debridement","code_information":[{"code":"21627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair stern/nuss w/o scope","code_information":[{"code":"21742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair sternum/nuss w/scope","code_information":[{"code":"21743","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Closed tx vert fx w/manj","code_information":[{"code":"22315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Perq cervicothoracic inject","code_information":[{"code":"22510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Perq lumbosacral injection","code_information":[{"code":"22511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release shoulder joint","code_information":[{"code":"23020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory shoulder surgery","code_information":[{"code":"23044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of shoulder joint","code_information":[{"code":"23100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder joint surgery","code_information":[{"code":"23101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of collarbone joint","code_information":[{"code":"23106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal collar bone","code_information":[{"code":"23120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of collar bone","code_information":[{"code":"23125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder bone part","code_information":[{"code":"23130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of scapula","code_information":[{"code":"23190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drain arm/elbow bone lesion","code_information":[{"code":"23935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Exploratory elbow surgery","code_information":[{"code":"24000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release elbow joint","code_information":[{"code":"24006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy elbow joint lining","code_information":[{"code":"24100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat elbow joint","code_information":[{"code":"24101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow joint lining","code_information":[{"code":"24102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of elbow bursa","code_information":[{"code":"24105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"24110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow lesion","code_information":[{"code":"24120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of head of radius","code_information":[{"code":"24130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove radius bone lesion","code_information":[{"code":"24136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of arm bone","code_information":[{"code":"24140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of elbow","code_information":[{"code":"24147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of elbow joint","code_information":[{"code":"24155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow joint implant","code_information":[{"code":"24160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove radius head implant","code_information":[{"code":"24164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Arm tendon lengthening","code_information":[{"code":"24305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm tendon","code_information":[{"code":"24310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Tenolysis triceps","code_information":[{"code":"24332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repr elbow lat ligmnt w/tiss","code_information":[{"code":"24343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow perc","code_information":[{"code":"24357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow w/deb open","code_information":[{"code":"24358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair elbow deb/attch open","code_information":[{"code":"24359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of elbow joint","code_information":[{"code":"24470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incise flexor carpi radialis","code_information":[{"code":"25001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 1 space","code_information":[{"code":"25023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompress forearm 2 spaces","code_information":[{"code":"25024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of forearm lesion","code_information":[{"code":"25028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of wrist capsule","code_information":[{"code":"25085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of wrist joint","code_information":[{"code":"25100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat wrist joint","code_information":[{"code":"25101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"25105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint cartilage","code_information":[{"code":"25107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Excise tendon forearm/wrist","code_information":[{"code":"25109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist/forearm lesion","code_information":[{"code":"25116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of forearm lesion","code_information":[{"code":"25120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft forearm lesion","code_information":[{"code":"25126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist lesion","code_information":[{"code":"25130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove forearm bone lesion","code_information":[{"code":"25145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist bone","code_information":[{"code":"25210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist bones","code_information":[{"code":"25215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"25230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of ulna","code_information":[{"code":"25240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of wrist prosthesis","code_information":[{"code":"25251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon sheath","code_information":[{"code":"25275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise wrist/forearm tendon","code_information":[{"code":"25280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incise wrist/forearm tendon","code_information":[{"code":"25290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release wrist/forearm tendon","code_information":[{"code":"25295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tendons at wrist","code_information":[{"code":"25301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transplant forearm tendon","code_information":[{"code":"25312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise wrist joint","code_information":[{"code":"25332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of hand","code_information":[{"code":"25335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of radius","code_information":[{"code":"25355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius or ulna","code_information":[{"code":"25370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair carpal bone shorten","code_information":[{"code":"25394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Vasc graft into carpal bone","code_information":[{"code":"25430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair wrist joints","code_information":[{"code":"25447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Arthrp ntrcrpl/crp/mtcrp ssp","code_information":[{"code":"25448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of wrist joint","code_information":[{"code":"25455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce radius and ulna","code_information":[{"code":"25492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Distal Radial","code_information":[{"code":"25606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Pin ulnar styloid fracture","code_information":[{"code":"25651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Pin radioulnar dislocation","code_information":[{"code":"25671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputate hand at wrist","code_information":[{"code":"25920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of hand","code_information":[{"code":"25927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drain hand tendon sheath","code_information":[{"code":"26020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of palm bursa","code_information":[{"code":"26025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of palm bursas","code_information":[{"code":"26030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompress fingers/hand","code_information":[{"code":"26037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat finger joint","code_information":[{"code":"26075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy hand joint lining","code_information":[{"code":"26100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy finger joint lining","code_information":[{"code":"26105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release palm contracture","code_information":[{"code":"26123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint lining","code_information":[{"code":"26130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint each","code_information":[{"code":"26135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft finger lesion","code_information":[{"code":"26215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of hand bone","code_information":[{"code":"26230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Extensive hand surgery","code_information":[{"code":"26250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect prox finger tumor","code_information":[{"code":"26260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Excision hand/finger tendon","code_information":[{"code":"26415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Graft hand or finger tendon","code_information":[{"code":"26416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger/hand tendon","code_information":[{"code":"26426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair finger tendon","code_information":[{"code":"26433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft finger tendon","code_information":[{"code":"26434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of tendons","code_information":[{"code":"26437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release palm & finger tendon","code_information":[{"code":"26442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release hand/finger tendon","code_information":[{"code":"26445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release forearm/hand tendon","code_information":[{"code":"26449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of palm tendon","code_information":[{"code":"26450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger tendons","code_information":[{"code":"26471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Tendon lengthening","code_information":[{"code":"26476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Tendon shortening","code_information":[{"code":"26477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of hand tendon","code_information":[{"code":"26478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shortening of hand tendon","code_information":[{"code":"26479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transplant hand tendon","code_information":[{"code":"26480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transplant/graft hand tendon","code_information":[{"code":"26483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transplant palm tendon","code_information":[{"code":"26485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transplant/graft palm tendon","code_information":[{"code":"26489","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Tendon transfer with graft","code_information":[{"code":"26492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon/muscle transfer","code_information":[{"code":"26494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise thumb tendon","code_information":[{"code":"26496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Finger tendon transfer","code_information":[{"code":"26498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of finger","code_information":[{"code":"26499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release thumb contracture","code_information":[{"code":"26508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Thumb tendon transfer","code_information":[{"code":"26510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joint","code_information":[{"code":"26516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release knuckle contracture","code_information":[{"code":"26520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise finger joint","code_information":[{"code":"26535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint","code_information":[{"code":"26540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand joint with graft","code_information":[{"code":"26542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct finger joint","code_information":[{"code":"26548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Construct thumb replacement","code_information":[{"code":"26550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of web finger","code_information":[{"code":"26562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Correct metacarpal flaw","code_information":[{"code":"26565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Correct finger deformity","code_information":[{"code":"26567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair hand deformity","code_information":[{"code":"26580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct extra finger","code_information":[{"code":"26587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair muscles of hand","code_information":[{"code":"26591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release muscles of hand","code_information":[{"code":"26593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Excision constricting tissue","code_information":[{"code":"26596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat metacarpal fracture","code_information":[{"code":"26615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat thumb fracture","code_information":[{"code":"26665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Pin hand dislocation","code_information":[{"code":"26676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat hand dislocation","code_information":[{"code":"26686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Pin knuckle dislocation","code_information":[{"code":"26706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat knuckle dislocation","code_information":[{"code":"26715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Pin finger fracture each","code_information":[{"code":"26756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger fracture each","code_information":[{"code":"26765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Pin finger dislocation","code_information":[{"code":"26776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat finger dislocation","code_information":[{"code":"26785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of finger joint","code_information":[{"code":"26860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of finger joint","code_information":[{"code":"26862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputate metacarpal bone","code_information":[{"code":"26910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of finger/thumb","code_information":[{"code":"26952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvis lesion","code_information":[{"code":"26990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"26992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendons","code_information":[{"code":"27006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip/thigh fascia","code_information":[{"code":"27025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Denervation of hip joint","code_information":[{"code":"27035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip joint lining","code_information":[{"code":"27054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/bursa","code_information":[{"code":"27062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip bone les deep","code_information":[{"code":"27066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Part remove hip bone super","code_information":[{"code":"27070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Part removal hip bone deep","code_information":[{"code":"27071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tail bone","code_information":[{"code":"27080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip foreign body","code_information":[{"code":"27087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip tendon","code_information":[{"code":"27097","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transfer tendon to pelvis","code_information":[{"code":"27098","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of spinal muscle","code_information":[{"code":"27105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of femur epiphysis","code_information":[{"code":"27185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat tail bone fracture","code_information":[{"code":"27202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Cltx thigh fx","code_information":[{"code":"27267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of pubic bones","code_information":[{"code":"27282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of bone lesion","code_information":[{"code":"27303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incise thigh tendon & fascia","code_information":[{"code":"27305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of knee joint","code_information":[{"code":"27310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy knee joint lining","code_information":[{"code":"27330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat knee joint","code_information":[{"code":"27331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cartilage","code_information":[{"code":"27333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kneecap bursa","code_information":[{"code":"27340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee cyst","code_information":[{"code":"27345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee cyst","code_information":[{"code":"27347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion","code_information":[{"code":"27355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal leg bone(s)","code_information":[{"code":"27360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect femur/knee tumor","code_information":[{"code":"27365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendon","code_information":[{"code":"27390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh tendons","code_information":[{"code":"27392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Lat retinacular release open","code_information":[{"code":"27425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of knee joint","code_information":[{"code":"27435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputate leg at thigh","code_information":[{"code":"27592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputate lower leg at knee","code_information":[{"code":"27598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of lower leg","code_information":[{"code":"27602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Drain lower leg bursa","code_information":[{"code":"27604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of achilles tendon","code_information":[{"code":"27606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg bone lesion","code_information":[{"code":"27607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of ankle joint","code_information":[{"code":"27612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Explore/treat ankle joint","code_information":[{"code":"27620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove ankle joint lining","code_information":[{"code":"27626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tendon lesion","code_information":[{"code":"27630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove lower leg bone lesion","code_information":[{"code":"27635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of tibia","code_information":[{"code":"27640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of fibula","code_information":[{"code":"27641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect tibia tumor","code_information":[{"code":"27645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect fibula tumor","code_information":[{"code":"27646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect talus/calcaneus tum","code_information":[{"code":"27647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair leg fascia defect","code_information":[{"code":"27656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release of lower leg tendon","code_information":[{"code":"27680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release of lower leg tendons","code_information":[{"code":"27681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower leg tendon","code_information":[{"code":"27685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendons","code_information":[{"code":"27686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of calf tendon","code_information":[{"code":"27687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle implant","code_information":[{"code":"27704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of fibula","code_information":[{"code":"27707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of tibia epiphysis","code_information":[{"code":"27730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of fibula epiphysis","code_information":[{"code":"27732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg epiphyses","code_information":[{"code":"27734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg epiphyses","code_information":[{"code":"27742","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of ankle joint","code_information":[{"code":"27860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"27886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of foot infection","code_information":[{"code":"28003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot bone lesion","code_information":[{"code":"28005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of foot fascia","code_information":[{"code":"28008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of foot joint","code_information":[{"code":"28022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of foot joint lining","code_information":[{"code":"28052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of toe joint lining","code_information":[{"code":"28054","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal foot fascia","code_information":[{"code":"28060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot fascia","code_information":[{"code":"28062","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28072","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Excise foot tendon sheath","code_information":[{"code":"28088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle/heel lesion","code_information":[{"code":"28100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot lesion","code_information":[{"code":"28104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of metatarsal","code_information":[{"code":"28113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of metatarsal heads","code_information":[{"code":"28114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot","code_information":[{"code":"28116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of heel bone","code_information":[{"code":"28118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of heel spur","code_information":[{"code":"28119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Part removal of ankle/heel","code_information":[{"code":"28120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of metatarsal","code_information":[{"code":"28140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of toe","code_information":[{"code":"28150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of toe","code_information":[{"code":"28160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect tarsal tumor","code_information":[{"code":"28171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect metatarsal tumor","code_information":[{"code":"28173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot tendon","code_information":[{"code":"28208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendon","code_information":[{"code":"28225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot tendons","code_information":[{"code":"28226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release of big toe","code_information":[{"code":"28240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot fascia","code_information":[{"code":"28250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release of midfoot joint","code_information":[{"code":"28260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Release of foot contracture","code_information":[{"code":"28270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of toes","code_information":[{"code":"28280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of hammertoe","code_information":[{"code":"28286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of foot bone","code_information":[{"code":"28288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Corrj halux rigdus w/o implt","code_information":[{"code":"28289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Revision of toe","code_information":[{"code":"28312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair deformity of toe","code_information":[{"code":"28313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Removal of sesamoid bone","code_information":[{"code":"28315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect enlarged toe tissue","code_information":[{"code":"28340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Resect enlarged toe","code_information":[{"code":"28341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair extra toe(s)","code_information":[{"code":"28344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat big toe fracture","code_information":[{"code":"28505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe fracture","code_information":[{"code":"28525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair toe dislocation","code_information":[{"code":"28645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Treat toe dislocation","code_information":[{"code":"28666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Repair of toe dislocation","code_information":[{"code":"28675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of midfoot","code_information":[{"code":"28800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation thru metatarsal","code_information":[{"code":"28805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation toe & metatarsal","code_information":[{"code":"28810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of toe","code_information":[{"code":"28820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Partial amputation of toe","code_information":[{"code":"28825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Jaw arthroscopy/surgery","code_information":[{"code":"29804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy dx","code_information":[{"code":"29805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy","code_information":[{"code":"29830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy","code_information":[{"code":"29840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthr0 w/synovectomy","code_information":[{"code":"29863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy dx","code_information":[{"code":"29870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/drainage","code_information":[{"code":"29871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29877","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29891","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Scope plantar fasciotomy","code_information":[{"code":"29893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29894","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29895","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29897","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy dx","code_information":[{"code":"29900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Mcp joint arthroscopy surg","code_information":[{"code":"29901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/fb rmvl","code_information":[{"code":"29904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/deb","code_information":[{"code":"29906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Rmv sk-mnt crnl nstm pg/rcvr","code_information":[{"code":"61892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Remove sympathetic nerves","code_information":[{"code":"64822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Sympathectomy supfc palmar","code_information":[{"code":"64823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl oi implt skl perq esp","code_information":[{"code":"69726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl oi implt skl tc esp","code_information":[{"code":"69727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Rmv ntr oi imp sktc esp>=100","code_information":[{"code":"69728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Tmj arthroscopy disc reposit","code_information":[{"code":"D7874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Open tx post pelvic fxcture","code_information":[{"code":"G0415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3246.04,"maximum":6814.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3656.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3519.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3416.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3553.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3799.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6814.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3621.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3587.73,"additional_payer_notes":"APC"}]}]},{"description":"Perq sacral augmt unilat inj","code_information":[{"code":"0200T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Perq sacral augmt bilat inj","code_information":[{"code":"0201T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt lumb","code_information":[{"code":"0221T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Perq lamot/lam crv/thrc","code_information":[{"code":"0274T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Extraosseous joint stblztion","code_information":[{"code":"0335T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl&rinsj sinus tarsi implt","code_information":[{"code":"0511T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Osteot hum xtrnl lngth dev","code_information":[{"code":"0594T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Replace tissue expander","code_information":[{"code":"11970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Open bone biopsy","code_information":[{"code":"20251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Adjust bone fixation device","code_information":[{"code":"20693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone for graft","code_information":[{"code":"20902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of tendon for graft","code_information":[{"code":"20924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fibula bone graft microvasc","code_information":[{"code":"20955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Iliac bone graft microvasc","code_information":[{"code":"20956","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Mt bone graft microvasc","code_information":[{"code":"20957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Other bone graft microvasc","code_information":[{"code":"20962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft microvasc","code_information":[{"code":"20969","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft iliac crest","code_information":[{"code":"20970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft metatarsal","code_information":[{"code":"20972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Bone/skin graft great toe","code_information":[{"code":"20973","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20983","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of rib","code_information":[{"code":"21600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Exc ch wal tum w/o lymphadec","code_information":[{"code":"21602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Exc ch wal tum w/lymphadec","code_information":[{"code":"21603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rib","code_information":[{"code":"21615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rib and nerves","code_information":[{"code":"21616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Extensive sternum surgery","code_information":[{"code":"21630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle","code_information":[{"code":"21700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of neck muscle/rib","code_information":[{"code":"21705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of sternum","code_information":[{"code":"21740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of sternum separation","code_information":[{"code":"21750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Optx of rib fx w/fixj scope","code_information":[{"code":"21811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rib fracture","code_information":[{"code":"21812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat sternum fracture","code_information":[{"code":"21825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"I&d p-spine c/t/cerv-thor","code_information":[{"code":"22010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"I&d abscess p-spine l/s/ls","code_information":[{"code":"22015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove part of neck vertebra","code_information":[{"code":"22110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove part thorax vertebra","code_information":[{"code":"22112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove part lumbar vertebra","code_information":[{"code":"22114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incis spine 3 column thorac","code_information":[{"code":"22206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incis spine 3 column lumbar","code_information":[{"code":"22207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg cerv","code_information":[{"code":"22210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg thorac","code_information":[{"code":"22212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incis 1 vertebral seg lumbar","code_information":[{"code":"22214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy cervical","code_information":[{"code":"22220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy thoracic","code_information":[{"code":"22222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incis w/discectomy lumbar","code_information":[{"code":"22224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Perq vertebral augmentation","code_information":[{"code":"22514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of spinal fusion","code_information":[{"code":"22830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine fixation device","code_information":[{"code":"22855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove cerv artif disc","code_information":[{"code":"22864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove Lumb Artif Disc","code_information":[{"code":"22865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder joint lining","code_information":[{"code":"23105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Explore treat shoulder joint","code_information":[{"code":"23107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bone lesion","code_information":[{"code":"23146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of humerus lesion","code_information":[{"code":"23156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove collar bone lesion","code_information":[{"code":"23180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove shoulder blade lesion","code_information":[{"code":"23182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove humerus lesion","code_information":[{"code":"23184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of head of humerus","code_information":[{"code":"23195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect clavicle tumor","code_information":[{"code":"23200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect scapula tumor","code_information":[{"code":"23210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect prox humerus tumor","code_information":[{"code":"23220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder prosthesis removal","code_information":[{"code":"23335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Muscle transfer shoulder/arm","code_information":[{"code":"23395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Muscle transfers","code_information":[{"code":"23397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fixation of shoulder blade","code_information":[{"code":"23400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tendon & muscle","code_information":[{"code":"23405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incise tendon(s) & muscle(s)","code_information":[{"code":"23406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair rotator cuff acute","code_information":[{"code":"23410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair rotator cuff chronic","code_information":[{"code":"23412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Release of shoulder ligament","code_information":[{"code":"23415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of shoulder","code_information":[{"code":"23420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair biceps tendon","code_information":[{"code":"23430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/transplant tendon","code_information":[{"code":"23440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair shoulder capsule","code_information":[{"code":"23466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce clavicle","code_information":[{"code":"23490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle fracture","code_information":[{"code":"23515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat clavicle dislocation","code_information":[{"code":"23552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat scapula fracture","code_information":[{"code":"23585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat shoulder dislocation","code_information":[{"code":"23660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"24126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm bone lesion","code_information":[{"code":"24134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove elbow bone lesion","code_information":[{"code":"24138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of radius","code_information":[{"code":"24145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Radical resection of elbow","code_information":[{"code":"24149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect distal humerus tumor","code_information":[{"code":"24150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect radius tumor","code_information":[{"code":"24152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Muscle/tendon transfer","code_information":[{"code":"24301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of arm tendon","code_information":[{"code":"24320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of arm muscles","code_information":[{"code":"24331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of biceps tendon","code_information":[{"code":"24340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair arm tendon/muscle","code_information":[{"code":"24341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ruptured tendon","code_information":[{"code":"24342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow lat ligmnt","code_information":[{"code":"24344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repr elbw med ligmnt w/tissu","code_information":[{"code":"24345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of forearm","code_information":[{"code":"24495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow dislocation","code_information":[{"code":"24615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat ulnar fracture","code_information":[{"code":"24685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of elbow joint","code_information":[{"code":"24800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"24930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of amputation","code_information":[{"code":"24935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat forearm bone lesion","code_information":[{"code":"25035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove & graft wrist lesion","code_information":[{"code":"25136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect radius/ulnar tumor","code_information":[{"code":"25170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair forearm tendon/muscle","code_information":[{"code":"25263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise palsy hand tendon(s)","code_information":[{"code":"25316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/revise wrist joint","code_information":[{"code":"25320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct ulna/radioulnar","code_information":[{"code":"25337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of radius","code_information":[{"code":"25350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ulna","code_information":[{"code":"25360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Shorten radius or ulna","code_information":[{"code":"25390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Shorten radius & ulna","code_information":[{"code":"25392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen radius & ulna","code_information":[{"code":"25393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair radius or ulna","code_information":[{"code":"25400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair radius & ulna","code_information":[{"code":"25415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius & ulna","code_information":[{"code":"25420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft radius or ulna","code_information":[{"code":"25425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair nonunion carpal bone","code_information":[{"code":"25431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft wrist bone","code_information":[{"code":"25440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove wrist joint implant","code_information":[{"code":"25449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce radius","code_information":[{"code":"25490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of radius","code_information":[{"code":"25526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture of ulna","code_information":[{"code":"25545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius & ulna","code_information":[{"code":"25574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture radius/ulna","code_information":[{"code":"25575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Rad Extra-Articul","code_information":[{"code":"25607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Rad Intra-Articul","code_information":[{"code":"25608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat Fx Radial 3+ Frag","code_information":[{"code":"25609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist bone fracture","code_information":[{"code":"25628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat fracture ulnar styloid","code_information":[{"code":"25652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist fracture","code_information":[{"code":"25685","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat wrist dislocation","code_information":[{"code":"25695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of wrist joint","code_information":[{"code":"25800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hand bones","code_information":[{"code":"25820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fuse hand bones with graft","code_information":[{"code":"25825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion radioulnar jnt/ulna","code_information":[{"code":"25830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Amputation follow-up surgery","code_information":[{"code":"25909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of forearm","code_information":[{"code":"25915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft bone lesion","code_information":[{"code":"26205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise hand/finger tendon","code_information":[{"code":"26390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft hand tendon","code_information":[{"code":"26392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Hand tendon reconstruction","code_information":[{"code":"26500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle joints","code_information":[{"code":"26518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise knuckle joint","code_information":[{"code":"26530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise knuckle with implant","code_information":[{"code":"26531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise/implant finger joint","code_information":[{"code":"26536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair nonunion hand","code_information":[{"code":"26546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Great toe-hand transfer","code_information":[{"code":"26551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Single transfer toe-hand","code_information":[{"code":"26553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Double transfer toe-hand","code_information":[{"code":"26554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Positional change of finger","code_information":[{"code":"26555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Toe joint transfer","code_information":[{"code":"26556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen metacarpal/finger","code_information":[{"code":"26568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of thumb","code_information":[{"code":"26841","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Thumb fusion with graft","code_information":[{"code":"26842","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hand joint","code_information":[{"code":"26843","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of hand joint","code_information":[{"code":"26844","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle","code_information":[{"code":"26850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knuckle with graft","code_information":[{"code":"26852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip tendon","code_information":[{"code":"27003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Buttock fasciotomy","code_information":[{"code":"27027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of hip joint","code_information":[{"code":"27030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Exploration of hip joint","code_information":[{"code":"27033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Excision of hip joint/muscle","code_information":[{"code":"27036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ischial bursa","code_information":[{"code":"27060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove hip bone les super","code_information":[{"code":"27065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft hip bone lesion","code_information":[{"code":"27067","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tumor","code_information":[{"code":"27075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tum incl acetabul","code_information":[{"code":"27076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Resect hip tum w/innom bone","code_information":[{"code":"27077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Rsect hip tum incl femur","code_information":[{"code":"27078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of abdominal muscle","code_information":[{"code":"27100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Transfer of iliopsoas muscle","code_information":[{"code":"27110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27122","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Transplant femur ridge","code_information":[{"code":"27140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip bone","code_information":[{"code":"27146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip bone","code_information":[{"code":"27147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of hip bones","code_information":[{"code":"27151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of hip bones","code_information":[{"code":"27156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pelvis","code_information":[{"code":"27158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of neck of femur","code_information":[{"code":"27161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision/fixation of femur","code_information":[{"code":"27165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft femur head/neck","code_information":[{"code":"27170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise head/neck of femur","code_information":[{"code":"27179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat slipped epiphysis","code_information":[{"code":"27181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce hip bones","code_information":[{"code":"27187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip wall fracture","code_information":[{"code":"27226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip fracture(s)","code_information":[{"code":"27228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fracture","code_information":[{"code":"27248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat hip dislocation","code_information":[{"code":"27254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Optx thigh fx","code_information":[{"code":"27269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove knee joint lining","code_information":[{"code":"27335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of kneecap","code_information":[{"code":"27350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of kneecap tendon","code_information":[{"code":"27380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft kneecap tendon","code_information":[{"code":"27381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of thigh muscle","code_information":[{"code":"27385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of thigh muscle","code_information":[{"code":"27386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendon","code_information":[{"code":"27393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh tendons","code_information":[{"code":"27394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Transplant of thigh tendon","code_information":[{"code":"27396","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Transplants of thigh tendons","code_information":[{"code":"27397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise thigh muscles/tendons","code_information":[{"code":"27400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee cartilage","code_information":[{"code":"27403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligament","code_information":[{"code":"27407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of knee ligaments","code_information":[{"code":"27409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Autochondrocyte implant knee","code_information":[{"code":"27412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral knee autograft","code_information":[{"code":"27416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair degenerated kneecap","code_information":[{"code":"27418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of unstable kneecap","code_information":[{"code":"27422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal of kneecap","code_information":[{"code":"27424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of thigh muscles","code_information":[{"code":"27430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise kneecap","code_information":[{"code":"27437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh","code_information":[{"code":"27448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of thigh","code_information":[{"code":"27450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of thigh bone","code_information":[{"code":"27454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of knee","code_information":[{"code":"27455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of knee","code_information":[{"code":"27457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Osteot femur imed lngth dev","code_information":[{"code":"27458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Shortening of thigh bone","code_information":[{"code":"27465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Lengthening of thigh bone","code_information":[{"code":"27466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of thigh","code_information":[{"code":"27470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of thigh","code_information":[{"code":"27472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27477","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Surgery to stop leg growth","code_information":[{"code":"27485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce thigh","code_information":[{"code":"27495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of thigh/knee","code_information":[{"code":"27499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat thigh fx growth plate","code_information":[{"code":"27519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap fracture","code_information":[{"code":"27524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee fracture","code_information":[{"code":"27540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat knee dislocation","code_information":[{"code":"27558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat kneecap dislocation","code_information":[{"code":"27566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft leg bone lesion","code_information":[{"code":"27638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair achilles tendon","code_information":[{"code":"27650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft achilles tendon","code_information":[{"code":"27652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of achilles tendon","code_information":[{"code":"27654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of leg tendon each","code_information":[{"code":"27665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair lower leg tendons","code_information":[{"code":"27676","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revise lower leg tendon","code_information":[{"code":"27691","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligaments","code_information":[{"code":"27696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of ankle ligament","code_information":[{"code":"27698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of ankle joint","code_information":[{"code":"27700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tibia","code_information":[{"code":"27705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Osteot tibia imed lngth dev","code_information":[{"code":"27713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of tibia","code_information":[{"code":"27720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of tibia","code_information":[{"code":"27724","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of lower leg","code_information":[{"code":"27725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair fibula nonunion","code_information":[{"code":"27726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce tibia","code_information":[{"code":"27745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Optx medial ankle fx","code_information":[{"code":"27766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Optx post ankle fx","code_information":[{"code":"27769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of fibula fracture","code_information":[{"code":"27784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27814","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"27823","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg joint","code_information":[{"code":"27829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg dislocation","code_information":[{"code":"27832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27846","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle dislocation","code_information":[{"code":"27848","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of lower leg","code_information":[{"code":"27880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of foot at ankle","code_information":[{"code":"27889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Decompression of leg","code_information":[{"code":"27893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of foot joint lining","code_information":[{"code":"28070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove/graft foot lesion","code_information":[{"code":"28107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ankle bone","code_information":[{"code":"28130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair/graft of foot tendon","code_information":[{"code":"28210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot tendon","code_information":[{"code":"28238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot and ankle","code_information":[{"code":"28262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Corrj halux rigdus w/implt","code_information":[{"code":"28291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of heel bone","code_information":[{"code":"28300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of ankle bone","code_information":[{"code":"28302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of midfoot bones","code_information":[{"code":"28304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incise/graft midfoot bones","code_information":[{"code":"28305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsal","code_information":[{"code":"28307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Incision of metatarsals","code_information":[{"code":"28309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Revision of big toe","code_information":[{"code":"28310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair of metatarsals","code_information":[{"code":"28322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct cleft foot","code_information":[{"code":"28360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of heel fracture","code_information":[{"code":"28406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat heel fracture","code_information":[{"code":"28415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of ankle fracture","code_information":[{"code":"28436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat ankle fracture","code_information":[{"code":"28445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral talus autogrft","code_information":[{"code":"28446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture","code_information":[{"code":"28456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat midfoot fracture each","code_information":[{"code":"28465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat metatarsal fracture","code_information":[{"code":"28485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat sesamoid bone fracture","code_information":[{"code":"28531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Treat foot dislocation","code_information":[{"code":"28576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Repair foot dislocation","code_information":[{"code":"28615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of big toe joint","code_information":[{"code":"28760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Shoulder arthroscopy/surgery","code_information":[{"code":"29820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscop rotator cuff repr","code_information":[{"code":"29827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Arthroscopy biceps tenodesis","code_information":[{"code":"29828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Elbow arthroscopy/surgery","code_information":[{"code":"29836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Wrist arthroscopy/surgery","code_information":[{"code":"29847","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29855","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthroscopy dx","code_information":[{"code":"29860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/fb removal","code_information":[{"code":"29861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthr0 w/debridement","code_information":[{"code":"29862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Autgrft implnt knee w/scope","code_information":[{"code":"29866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Meniscal trnspl knee w/scpe","code_information":[{"code":"29868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29887","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Ankle arthroscopy/surgery","code_information":[{"code":"29899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/exc","code_information":[{"code":"29905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/femoroplasty","code_information":[{"code":"29914","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro acetabuloplasty","code_information":[{"code":"29915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Hip arthro w/labral repair","code_information":[{"code":"29916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Dcmprn prq rmv lig flv 1lmbr","code_information":[{"code":"62330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Implant spinal canal cath","code_information":[{"code":"62351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Ndsc dcmprn 1 ntrspc lumbar","code_information":[{"code":"62380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 crvl","code_information":[{"code":"63001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 thrc","code_information":[{"code":"63003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 lmbr","code_information":[{"code":"63005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1/2 scrl","code_information":[{"code":"63011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove lamina/facets lumbar","code_information":[{"code":"63012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 crvcl","code_information":[{"code":"63015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 thrc","code_information":[{"code":"63016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina >2 lmbr","code_information":[{"code":"63017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Low back disk surgery","code_information":[{"code":"63030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Laminotomy single cervical","code_information":[{"code":"63040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Laminotomy single lumbar","code_information":[{"code":"63042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 crvl","code_information":[{"code":"63045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 thrc","code_information":[{"code":"63046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine lamina 1 lmbr","code_information":[{"code":"63047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord thrc","code_information":[{"code":"63055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord lmbr","code_information":[{"code":"63056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Decompress spinal cord thrc","code_information":[{"code":"63064","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine disk surgery","code_information":[{"code":"63075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Excise intraspinl lesion crv","code_information":[{"code":"63265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion thrc","code_information":[{"code":"63266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion lmbr","code_information":[{"code":"63267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Excise intrspinl lesion scrl","code_information":[{"code":"63268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Temple Bone Implant Revision","code_information":[{"code":"69717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Pild/placebo control clin tr","code_information":[{"code":"G0276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Open tx iliac spine uni/bil","code_information":[{"code":"G0412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic ring fracture uni/bil","code_information":[{"code":"G0413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Pelvic ring fx treat int fix","code_information":[{"code":"G0414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7198.64,"maximum":15111.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8107.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7804.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7198.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7577.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7880.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8426.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15111.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7956.39,"additional_payer_notes":"APC"}]}]},{"description":"Post vert arthrplst 1 lumbar","code_information":[{"code":"0202T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt cerv","code_information":[{"code":"0219T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Plmt post facet implt thor","code_information":[{"code":"0220T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc fluor lmbr 1st","code_information":[{"code":"0627T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Perq njx algc ct lmbr 1st","code_information":[{"code":"0629T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Xenograft impltj artclr surf","code_information":[{"code":"0737T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Arthrp 1st crp/mtcrpl prostc","code_information":[{"code":"1003T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Apply bone fixation device","code_information":[{"code":"20692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat odontoid fx w/o graft","code_information":[{"code":"22318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat odontoid fx w/graft","code_information":[{"code":"22319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat spine fracture","code_information":[{"code":"22325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat neck spine fracture","code_information":[{"code":"22326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat thorax spine fracture","code_information":[{"code":"22327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Lat thorax spine fusion","code_information":[{"code":"22532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fuse&remov bel c2","code_information":[{"code":"22551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Spine & skull spinal fusion","code_information":[{"code":"22590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Neck spinal fusion","code_information":[{"code":"22595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reinsert spinal fixation","code_information":[{"code":"22849","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/o dcmprn","code_information":[{"code":"22869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revis reconst shoulder joint","code_information":[{"code":"23474","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of collar bone","code_information":[{"code":"23485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce shoulder bones","code_information":[{"code":"23491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat dislocation/fracture","code_information":[{"code":"23680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of shoulder joint","code_information":[{"code":"23802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of arm & girdle","code_information":[{"code":"23900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Amputation at shoulder joint","code_information":[{"code":"23920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow med ligmnt","code_information":[{"code":"24346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct head of radius","code_information":[{"code":"24366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of humerus","code_information":[{"code":"24410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Repair of humerus","code_information":[{"code":"24430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Repair humerus with graft","code_information":[{"code":"24435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce humerus","code_information":[{"code":"24498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"24579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat elbow fracture","code_information":[{"code":"24587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat radius fracture","code_information":[{"code":"24666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of elbow joint","code_information":[{"code":"24802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of upper arm","code_information":[{"code":"24920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Amputate upper arm & implant","code_information":[{"code":"24931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of upper arm","code_information":[{"code":"24940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revise radius & ulna","code_information":[{"code":"25365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Lengthen radius or ulna","code_information":[{"code":"25391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25444","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reinforce ulna","code_information":[{"code":"25491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion/graft of wrist joint","code_information":[{"code":"25810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hip prosthesis","code_information":[{"code":"27091","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of hip socket","code_information":[{"code":"27120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Partial hip replacement","code_information":[{"code":"27125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Total hip arthroplasty","code_information":[{"code":"27132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27137","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revise hip joint replacement","code_information":[{"code":"27138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of hip joint","code_information":[{"code":"27286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Remove femur lesion/graft","code_information":[{"code":"27356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Osteochondral knee allograft","code_information":[{"code":"27415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction knee","code_information":[{"code":"27429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revise kneecap with implant","code_information":[{"code":"27438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of knee joint","code_information":[{"code":"27446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Total knee arthroplasty","code_information":[{"code":"27447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Removal of knee prosthesis","code_information":[{"code":"27488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of thigh fracture","code_information":[{"code":"27514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of knee","code_information":[{"code":"27580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Incision of tibia & fibula","code_information":[{"code":"27709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Realignment of lower leg","code_information":[{"code":"27712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of lower leg","code_information":[{"code":"27715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27758","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of tibia fracture","code_information":[{"code":"27759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27827","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat lower leg fracture","code_information":[{"code":"27828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of ankle joint open","code_information":[{"code":"27870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of tibiofibular joint","code_information":[{"code":"27871","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Correction hallux valgus","code_information":[{"code":"28297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Repair of foot bones","code_information":[{"code":"28320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Treat/graft heel fracture","code_information":[{"code":"28420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revision of foot bones","code_information":[{"code":"28737","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Tibial arthroscopy/surgery","code_information":[{"code":"29856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Allgrft implnt knee w/scope","code_information":[{"code":"29867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Knee arthroscopy/surgery","code_information":[{"code":"29889","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Subtalar arthro w/fusion","code_information":[{"code":"29907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Trml dstrj ios bvn 1st 2 l/s","code_information":[{"code":"64628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Implant Temple Bone W/Stimul","code_information":[{"code":"69714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Impltj oi implt skl tc esp","code_information":[{"code":"69716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt oi implt tc esp","code_information":[{"code":"69719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Impl oi implt sk tc esp>=100","code_information":[{"code":"69729","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Rplc oi implt sk tc esp>=100","code_information":[{"code":"69730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"U/s trtmt, not leiomyomata","code_information":[{"code":"C9734","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Spine/lumbar disk surgery","code_information":[{"code":"C9757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Arthro/shoul surg; w/spacer","code_information":[{"code":"C9781","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12736.81,"maximum":26737.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14345.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13809.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12736.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13407.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13943.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14908.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26737.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14211.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14077.52,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant","code_information":[{"code":"0656T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Vrt bdy tethering ant 8+ seg","code_information":[{"code":"0657T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Revj rplcmt/rmvl vrt tethrg","code_information":[{"code":"0790T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Replantation arm complete","code_information":[{"code":"20802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Replant forearm complete","code_information":[{"code":"20805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Replantation hand complete","code_information":[{"code":"20808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Replantation foot complete","code_information":[{"code":"20838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Ablate bone tumor(s) perq","code_information":[{"code":"20982","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Lat lumbar spine fusion","code_information":[{"code":"22533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Prescrl fuse w/ instr l5-s1","code_information":[{"code":"22586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Neck spine fusion","code_information":[{"code":"22600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Thorax spine fusion","code_information":[{"code":"22610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar spine fusion","code_information":[{"code":"22612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion <=6 vert seg","code_information":[{"code":"22800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion 7-12 vert seg","code_information":[{"code":"22802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Post fusion 13/> vert seg","code_information":[{"code":"22804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 2-3 vert seg","code_information":[{"code":"22808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 4-7 vert seg","code_information":[{"code":"22810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Ant fusion 8/> vert seg","code_information":[{"code":"22812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Kyphectomy 1-2 segments","code_information":[{"code":"22818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Kyphectomy 3 or more","code_information":[{"code":"22819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Ant thrc vrt body tethrg <7","code_information":[{"code":"22836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Ant thrc vrt body tethrg 8+","code_information":[{"code":"22837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Rev rplc/rmv thrc vrt tethrg","code_information":[{"code":"22838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Cerv artific diskectomy","code_information":[{"code":"22856","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Lumbar Artif Diskectomy","code_information":[{"code":"22857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Revise cerv artific disc","code_information":[{"code":"22861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Revise Lumbar Artif Disc","code_information":[{"code":"22862","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Insj stablj dev w/dcmprn","code_information":[{"code":"22867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct shoulder joint","code_information":[{"code":"23472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Treat humerus fracture","code_information":[{"code":"23616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct elbow joint","code_information":[{"code":"24361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Replace elbow joint","code_information":[{"code":"24363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Revise reconst elbow joint","code_information":[{"code":"24371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruct wrist joint","code_information":[{"code":"25442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Wrist replacement","code_information":[{"code":"25446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Arthrd si jt prq wo tfxj dev","code_information":[{"code":"27278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Arthrodesis sacroiliac joint","code_information":[{"code":"27279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of sacroiliac joint","code_information":[{"code":"27280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Amputation of leg at hip","code_information":[{"code":"27295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Revise/replace knee joint","code_information":[{"code":"27487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction ankle joint","code_information":[{"code":"27703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Fusion of foot bones","code_information":[{"code":"28705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Imp extar knee shck absrb","code_information":[{"code":"C8003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17394.69,"maximum":36516.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19591.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18859.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17394.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18310.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19042.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20360.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36516.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19408.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19225.71,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy dx","code_information":[{"code":"31235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Nsl/sins ndsc w/artery lig","code_information":[{"code":"31241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy excl nb","code_information":[{"code":"31525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Dx laryngoscopy w/oper scope","code_information":[{"code":"31526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/fb removal","code_information":[{"code":"31530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/ther injection","code_information":[{"code":"31573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/njx augmentation","code_information":[{"code":"31574","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/wash","code_information":[{"code":"31622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/brush","code_information":[{"code":"31623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Dx bronchoscope/lavage","code_information":[{"code":"31624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/biopsy(s)","code_information":[{"code":"31625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/fb removal","code_information":[{"code":"31635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Diag bronchoscope/catheter","code_information":[{"code":"31643","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy clear airways","code_information":[{"code":"31645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve remov addl","code_information":[{"code":"31649","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Intro windpipe wire/tube","code_information":[{"code":"31730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Dise eval slp do brth flx dx","code_information":[{"code":"42975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1765.77,"maximum":3706.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1988.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1914.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1765.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1858.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1933.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2066.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3706.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1970.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1951.65,"additional_payer_notes":"APC"}]}]},{"description":"Nasal/sinus endoscopy surg","code_information":[{"code":"31239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Exploration maxillary sinus","code_information":[{"code":"31256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy with biopsy","code_information":[{"code":"31510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Removal of larynx lesion","code_information":[{"code":"31512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy for treatment","code_information":[{"code":"31527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy and dilation","code_information":[{"code":"31529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/fb & op scope","code_information":[{"code":"31531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/biopsy","code_information":[{"code":"31535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/bx & op scope","code_information":[{"code":"31536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopy w/exc of tumor","code_information":[{"code":"31540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Larynscop w/tumr exc + scope","code_information":[{"code":"31541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Remove vc lesion w/scope","code_information":[{"code":"31545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscope w/vc inj","code_information":[{"code":"31570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscop w/vc inj + scope","code_information":[{"code":"31571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/laser dstrj les","code_information":[{"code":"31572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Largsc w/removal lesion","code_information":[{"code":"31578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy/lung bx each","code_information":[{"code":"31628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy/needle bx each","code_information":[{"code":"31629","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy dilate/fx repr","code_information":[{"code":"31630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy w/tumor excise","code_information":[{"code":"31640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Bronchoscopy treat blockage","code_information":[{"code":"31641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial valve remov init","code_information":[{"code":"31648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Bronch ebus samplng 1/2 node","code_information":[{"code":"31652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Bronch ebus samplng 3/> node","code_information":[{"code":"31653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3698.76,"maximum":7764.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4165.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4010.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3698.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3893.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4049.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4329.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7764.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4127.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4088.11,"additional_payer_notes":"APC"}]}]},{"description":"Repos car modulj tranvns elt","code_information":[{"code":"0415T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Rpos prv ccm-d trnsvns eltrd","code_information":[{"code":"0924T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Active thrc irrigation spx","code_information":[{"code":"1021T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Remove lung catheter","code_information":[{"code":"32552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate pleura w/o imaging","code_information":[{"code":"32554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Aspirate pleura w/ imaging","code_information":[{"code":"32555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Treat pleurodesis w/agent","code_information":[{"code":"32560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Lyse chest fibrin init day","code_information":[{"code":"32561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Lyse chest fibrin subq day","code_information":[{"code":"32562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic pneumothorax","code_information":[{"code":"32960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Chest surgery procedure","code_information":[{"code":"32999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Cardiac surgery procedure","code_information":[{"code":"33999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Pseudoaneurysm injection trt","code_information":[{"code":"36002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Insj picc rs&i <5 yr","code_information":[{"code":"36572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Vascular endoscopy procedure","code_information":[{"code":"37501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Vascular surgery procedure","code_information":[{"code":"37799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":622.33,"maximum":1306.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":700.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":622.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":681.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":728.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1306.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":687.83,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of chest tube","code_information":[{"code":"32551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Insert cath pleura w/ image","code_information":[{"code":"32557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Pericardiocentesis w/imaging","code_information":[{"code":"33016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Insert picc cath","code_information":[{"code":"36568","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Insert picc cath","code_information":[{"code":"36569","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Insj picc rs&i 5 yr+","code_information":[{"code":"36573","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Repair tunneled cv cath","code_information":[{"code":"36576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Replace cvad cath","code_information":[{"code":"36580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Replace picc cath","code_information":[{"code":"36584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Removal tunneled cv cath","code_information":[{"code":"36590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Reposition venous catheter","code_information":[{"code":"36597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"External cannula declotting","code_information":[{"code":"36860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Insert/place heart catheter","code_information":[{"code":"93503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1561.66,"maximum":3278.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1758.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1561.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1643.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1827.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3278.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.05,"additional_payer_notes":"APC"}]}]},{"description":"Ev cath dir chem abltj w/img","code_information":[{"code":"0524T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 2chmbr ldls pm cmpl","code_information":[{"code":"0798T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm ra","code_information":[{"code":"0799T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl 2chmbr ldls pm rv","code_information":[{"code":"0800T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmv 1chmbr ldls pm ra","code_information":[{"code":"0824T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligation nasal sinus artery","code_information":[{"code":"30915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligation upper jaw artery","code_information":[{"code":"30920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Reposition pacing-defib lead","code_information":[{"code":"33215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Reposition l ventric lead","code_information":[{"code":"33226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl perm ldls pm","code_information":[{"code":"33275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Removal of vein clot","code_information":[{"code":"34490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Leg vein fusion","code_information":[{"code":"34530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Explore limb vessels","code_information":[{"code":"35860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Excision graft extremity","code_information":[{"code":"35903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Place cath thoracic aorta","code_information":[{"code":"36221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotid/inom art","code_information":[{"code":"36222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Place cath subclavian art","code_information":[{"code":"36225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 1st unilat","code_information":[{"code":"36251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 1st bilat","code_information":[{"code":"36252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 2nd+ bilat","code_information":[{"code":"36254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous mchnchem 1st vein","code_information":[{"code":"36473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous rf 1st vein","code_information":[{"code":"36475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Endovenous laser 1st vein","code_information":[{"code":"36478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insert non-tunnel cv cath","code_information":[{"code":"36556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insert picvad cath","code_information":[{"code":"36570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insert picvad cath","code_information":[{"code":"36571","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Replace picvad cath","code_information":[{"code":"36585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Mech remov tunneled cv cath","code_information":[{"code":"36595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insertion catheter artery","code_information":[{"code":"36640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Av fusion direct any site","code_information":[{"code":"36821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Artery to vein shunt","code_information":[{"code":"36835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Venous m-thrombectomy add-on","code_information":[{"code":"37188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Redo endovas vena cava filtr","code_information":[{"code":"37192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Rem endovas vena cava filter","code_information":[{"code":"37193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Remove intrvas foreign body","code_information":[{"code":"37197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic venous therapy","code_information":[{"code":"37212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Thromblytic art/ven therapy","code_information":[{"code":"37213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Cessj therapy cath removal","code_information":[{"code":"37214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck vein","code_information":[{"code":"37565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of a-v fistula","code_information":[{"code":"37607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of neck artery","code_information":[{"code":"37615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Revision of major vein","code_information":[{"code":"37650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Revise leg vein","code_information":[{"code":"37700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/strip short leg vein","code_information":[{"code":"37718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/strip long leg vein","code_information":[{"code":"37722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Removal of leg veins/lesion","code_information":[{"code":"37735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligate leg veins radical","code_information":[{"code":"37760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligate leg veins open","code_information":[{"code":"37761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Stab phleb veins xtr 10-20","code_information":[{"code":"37765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Phleb veins - extrem 20+","code_information":[{"code":"37766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Revision of leg vein","code_information":[{"code":"37780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Ligate/divide/excise vein","code_information":[{"code":"37785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Remove tunneled ip cath","code_information":[{"code":"49422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Removal of shunt","code_information":[{"code":"49429","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of heart lining","code_information":[{"code":"93505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3132.43,"maximum":6575.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3528.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3396.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3132.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3297.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3429.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3666.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6575.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3495.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3462.16,"additional_payer_notes":"APC"}]}]},{"description":"Insj bioprostc vlv fem vn","code_information":[{"code":"0744T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Removal of arm artery clot","code_information":[{"code":"34111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Removal of artery clot","code_information":[{"code":"34201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Removal of leg artery clot","code_information":[{"code":"34203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair valve femoral vein","code_information":[{"code":"34501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Transposition of vein valve","code_information":[{"code":"34510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Cross-over vein graft","code_information":[{"code":"34520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair defect of artery","code_information":[{"code":"35011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair defect of arm artery","code_information":[{"code":"35045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Repair blood vessel lesion","code_information":[{"code":"35286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Rechanneling of artery","code_information":[{"code":"35372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Explore neck vessels","code_information":[{"code":"35800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Removal of clot in graft","code_information":[{"code":"35875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Removal of clot in graft","code_information":[{"code":"35876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35879","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35881","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise Graft w/Nonauto Graft","code_information":[{"code":"35883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Revise graft w/vein","code_information":[{"code":"35884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotid/inom art","code_information":[{"code":"36223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Place cath carotd art","code_information":[{"code":"36224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Place cath vertebral art","code_information":[{"code":"36226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Ins cath ren art 2nd+ unilat","code_information":[{"code":"36253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of infusion pump","code_information":[{"code":"36260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Endoven ther chem adhes 1st","code_information":[{"code":"36482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Insert tunneled cv cath","code_information":[{"code":"36566","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Replace tunneled cv cath","code_information":[{"code":"36583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Insertion of cannula","code_information":[{"code":"36815","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Av fuse uppr arm cephalic","code_information":[{"code":"36818","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Av fuse uppr arm basilic","code_information":[{"code":"36819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Av fusion/forearm vein","code_information":[{"code":"36820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Artery-vein autograft","code_information":[{"code":"36825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Artery-vein nonautograft","code_information":[{"code":"36830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Open thrombect av fistula","code_information":[{"code":"36831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Av fistula revision open","code_information":[{"code":"36832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Av fistula revision","code_information":[{"code":"36833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Dist revas ligation hemo","code_information":[{"code":"36838","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Cannula declotting","code_information":[{"code":"36861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Ins endovas vena cava filtr","code_information":[{"code":"37191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Transcatheter biopsy","code_information":[{"code":"37200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic art therapy","code_information":[{"code":"37211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of abdomen artery","code_information":[{"code":"37617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of inf vena cava","code_information":[{"code":"37619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Insert tun ip cath w/port","code_information":[{"code":"49419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5520.33,"maximum":11588.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6217.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5985.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5520.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5810.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6461.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11588.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6159.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6101.42,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impl wrls l atr prs snr","code_information":[{"code":"0933T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"Right heart cath","code_information":[{"code":"93451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"Left hrt cath w/ventrclgrphy","code_information":[{"code":"93452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath w/ventriclgrphy","code_information":[{"code":"93453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"Coronary artery angio s&i","code_information":[{"code":"93454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"Coronary art/grft angio s&i","code_information":[{"code":"93455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R hrt coronary artery angio","code_information":[{"code":"93456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R hrt art/grft angio","code_information":[{"code":"93457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"L hrt artery/ventricle angio","code_information":[{"code":"93458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"L hrt art/grft angio","code_information":[{"code":"93459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt art/ventricle angio","code_information":[{"code":"93460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt art/ventricle angio","code_information":[{"code":"93461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R hrt cath chd nml nt cnj","code_information":[{"code":"93593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R hrt cath chd abnl nt cnj","code_information":[{"code":"93594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"L hrt cath chd nm/abn nt cnj","code_information":[{"code":"93595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath chd nml nt cnj","code_information":[{"code":"93596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"R&l hrt cath chd abnl nt cnj","code_information":[{"code":"93597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3216.21,"maximum":6751.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3622.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3487.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3216.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3385.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3764.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6751.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3588.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3554.76,"additional_payer_notes":"APC"}]}]},{"description":"Trnscth renal symp denrv unl","code_information":[{"code":"0338T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Trnscth renal symp denrv bil","code_information":[{"code":"0339T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Tcat rmvl/dblk icar mas perq","code_information":[{"code":"0644T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Remove hepatic shunt (tips)","code_information":[{"code":"37183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Trluml balo angiop 1st art","code_information":[{"code":"37246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Trluml balo angiop 1st vein","code_information":[{"code":"37248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt angio sf 1st","code_information":[{"code":"37254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt angio cplx 1","code_information":[{"code":"37256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc fpvt angio sf 1","code_information":[{"code":"37263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt angio cplx 1","code_information":[{"code":"37265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Prq cardiac angioplast 1 art","code_information":[{"code":"92920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Revision of aortic valve","code_information":[{"code":"92986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5646.40,"maximum":11853.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6359.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6121.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5646.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5943.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6181.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6609.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11853.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6300.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6240.76,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc renal art","code_information":[{"code":"0234T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc abd aorta","code_information":[{"code":"0236T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc brchiocph","code_information":[{"code":"0237T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Ev fempop artl revsc","code_information":[{"code":"0505T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat ther rx ntrac balo1","code_information":[{"code":"0913T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 nm nt uni","code_information":[{"code":"33900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 nm nt bi","code_information":[{"code":"33901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 abnor bi","code_information":[{"code":"33903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Intro cath dialysis circuit","code_information":[{"code":"36903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Venous mech thrombectomy","code_information":[{"code":"37187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Open/perq place stent 1st","code_information":[{"code":"37236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Open/perq place stent same","code_information":[{"code":"37238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude venous","code_information":[{"code":"37241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude organ","code_information":[{"code":"37243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude bleed","code_information":[{"code":"37244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt stent sf 1st","code_information":[{"code":"37258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc ivt st cplx 1st","code_information":[{"code":"37260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt stent sf 1st","code_information":[{"code":"37267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc fpvt st cplx 1st","code_information":[{"code":"37269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt angio sf 1st","code_information":[{"code":"37280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt angio cplx 1","code_information":[{"code":"37282","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc imvt angio sf 1","code_information":[{"code":"37296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc imvt angio cplx 1","code_information":[{"code":"37298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Endovasc tempory vessel occl","code_information":[{"code":"61623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Transcath occlusion non-cns","code_information":[{"code":"61626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Prq card angio/athrect 1 art","code_information":[{"code":"92924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Prq card stent w/angio 1 vsl","code_information":[{"code":"92928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Prq revasc byp graft 1 vsl","code_information":[{"code":"92937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Prq card revasc chronic 1vsl","code_information":[{"code":"92943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Prq trl rvs ch occ ant&rtrgr","code_information":[{"code":"92945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of mitral valve","code_information":[{"code":"92987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revision of pulmonary valve","code_information":[{"code":"92990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Pul art balloon repr percut","code_information":[{"code":"92997","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Sim ang w/prs cath rad emb","code_information":[{"code":"C8004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Perc drug-el cor stent sing","code_information":[{"code":"C9600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor revasc t cabg s","code_information":[{"code":"C9604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intravasc lithotripsy","code_information":[{"code":"C9764","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotrip tibi/perone","code_information":[{"code":"C9772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Blind cor sinus reducer impl","code_information":[{"code":"C9783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11452.59,"maximum":24041.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12899.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12417.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11452.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12055.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12537.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13405.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24041.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12778.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12658.12,"additional_payer_notes":"APC"}]}]},{"description":"Trluml perip athrc iliac art","code_information":[{"code":"0238T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Perq tcat us abltj nrv p-art","code_information":[{"code":"0632T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impltj c sins rdctj dev","code_information":[{"code":"0645T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat thrm ablt nrv p-art","code_information":[{"code":"0793T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Tcat impl wrls ivc snr","code_information":[{"code":"0981T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Perq p-art revsc 1 abnor uni","code_information":[{"code":"33902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Prq av fstl crtj uxtr 1 acs","code_information":[{"code":"36836","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Prq av fstl crt uxtr sep acs","code_information":[{"code":"36837","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Thrmbc/nfs dialysis circuit","code_information":[{"code":"36906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Insert hepatic shunt (tips)","code_information":[{"code":"37182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Prim art m-thrmbc 1st vsl","code_information":[{"code":"37184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Vasc embolize/occlude artery","code_information":[{"code":"37242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt athrc sf 1st","code_information":[{"code":"37271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc fpvt athrc cplx 1","code_information":[{"code":"37273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc fpvt st athrc sf 1","code_information":[{"code":"37275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc fpvt st athr cpx 1","code_information":[{"code":"37277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc tpvt st sf 1st","code_information":[{"code":"37284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evasc tpvt st cplx 1st","code_information":[{"code":"37286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt athrc sf 1st","code_information":[{"code":"37288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revsc evsc tpvt athrc cplx 1","code_information":[{"code":"37290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt st athrc sf 1","code_information":[{"code":"37292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Rvsc evsc tpvt st athr cpx 1","code_information":[{"code":"37294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Transcath occlusion cns","code_information":[{"code":"61624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Prq tcat plmt ntrac st 2+les","code_information":[{"code":"92930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Prq card stent/ath/angio","code_information":[{"code":"92933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Transcath closure of asd","code_information":[{"code":"93580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Transcath closure of vsd","code_information":[{"code":"93581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath closure pda","code_information":[{"code":"93582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath cls mitral","code_information":[{"code":"93590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Perq transcath cls aortic","code_information":[{"code":"93591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor stent ather s","code_information":[{"code":"C9602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Perc d-e cor revasc chro sin","code_information":[{"code":"C9607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intra lithotrip-stent","code_information":[{"code":"C9765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revasc intra lithotrip-ather","code_information":[{"code":"C9766","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotrip-stent-ather","code_information":[{"code":"C9767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotr-stent tib/per","code_information":[{"code":"C9773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lithotr-ather tib/per","code_information":[{"code":"C9774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Revasc lith-sten-ath tib/per","code_information":[{"code":"C9775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Vasc emb/occ w/prs cath","code_information":[{"code":"C9797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18186.18,"maximum":38177.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20483.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19717.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18186.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19143.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19909.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21287.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38177.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20291.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20100.51,"additional_payer_notes":"APC"}]}]},{"description":"Mag ctrld capsule endoscopy","code_information":[{"code":"0651T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Egd vol adjmt bariatric balo","code_information":[{"code":"0813T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Upr gi bld detcj snr capsule","code_information":[{"code":"0977T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Removal foreign body mouth","code_information":[{"code":"40804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex dx brush","code_information":[{"code":"43197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Esophagosc flex trnsn biopsy","code_information":[{"code":"43198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flexible brush","code_information":[{"code":"43200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Egd diagnostic brush wash","code_information":[{"code":"43235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Uppr gi scope w/submuc inj","code_information":[{"code":"43236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Egd biopsy single/multiple","code_information":[{"code":"43239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Egd remove foreign body","code_information":[{"code":"43247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Egd guide wire insertion","code_information":[{"code":"43248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx trnsorl rmvl balo","code_information":[{"code":"43291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Dilate esophagus 1/mult pass","code_information":[{"code":"43450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus surgery procedure","code_information":[{"code":"43499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Surgical opening of stomach","code_information":[{"code":"43510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Dx duod intub w/asp spec","code_information":[{"code":"43756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Dx duod intub w/asp specs","code_information":[{"code":"43757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Stomach surgery procedure","code_information":[{"code":"43999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of bowel","code_information":[{"code":"44100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Intro gastrointestinal tube","code_information":[{"code":"44500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted px small intestine","code_information":[{"code":"44799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Removal biliary drg cath","code_information":[{"code":"47537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Bile tract surgery procedure","code_information":[{"code":"47999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Abd paracentesis","code_information":[{"code":"49082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Abd paracentesis w/imaging","code_information":[{"code":"49083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Peritoneal lavage","code_information":[{"code":"49084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Replace g/c tube perc","code_information":[{"code":"49450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Replace duod/jej tube perc","code_information":[{"code":"49451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Replace g-j tube perc","code_information":[{"code":"49452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Fix g/colon tube w/device","code_information":[{"code":"49460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Abdomen surgery procedure","code_information":[{"code":"49999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Perq elec nrv field stimj cn","code_information":[{"code":"64567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Gi tract capsule endoscopy","code_information":[{"code":"91110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Esophageal Capsule Endoscopy","code_information":[{"code":"91111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Gi wireless capsule measure","code_information":[{"code":"91112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":899.79,"maximum":1888.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1013.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":975.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":899.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":947.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":985.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1053.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1888.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":994.5,"additional_payer_notes":"APC"}]}]},{"description":"Insj gtube perq mag gastrpxy","code_information":[{"code":"0647T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal dx br/wa","code_information":[{"code":"0652T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal bx 1/ml","code_information":[{"code":"0653T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Insert cath pleura w/o image","code_information":[{"code":"32556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid trnso dx","code_information":[{"code":"43191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso inject","code_information":[{"code":"43192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso biopsy","code_information":[{"code":"43193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp rig trnso rem fb","code_information":[{"code":"43194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscp guide wire dilat","code_information":[{"code":"43196","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esoph scope w/submucous inj","code_information":[{"code":"43201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex biopsy","code_information":[{"code":"43202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esoph scope w/sclerosis inj","code_information":[{"code":"43204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus endoscopy/ligation","code_information":[{"code":"43205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esoph optical endomicroscopy","code_information":[{"code":"43206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop mucosal resect","code_information":[{"code":"43211","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy retro balloon","code_information":[{"code":"43213","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagosc dilate balloon 30","code_information":[{"code":"43214","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy flex remove fb","code_information":[{"code":"43215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy lesion removal","code_information":[{"code":"43216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy snare les remv","code_information":[{"code":"43217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy balloon <30mm","code_information":[{"code":"43220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esoph endoscopy dilation","code_information":[{"code":"43226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy control bleed","code_information":[{"code":"43227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscop ultrasound exam","code_information":[{"code":"43231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy w/us needle bx","code_information":[{"code":"43232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd balloon dil esoph30 mm/>","code_information":[{"code":"43233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopic us exam esoph","code_information":[{"code":"43237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd tube/cath insertion","code_information":[{"code":"43241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd us fine needle bx/aspir","code_information":[{"code":"43242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd injection varices","code_information":[{"code":"43243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd varices ligation","code_information":[{"code":"43244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd dilate stricture","code_information":[{"code":"43245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd place gastrostomy tube","code_information":[{"code":"43246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Esoph egd dilation <30 mm","code_information":[{"code":"43249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd cautery tumor polyp","code_information":[{"code":"43250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd remove lesion snare","code_information":[{"code":"43251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd optical endomicroscopy","code_information":[{"code":"43252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd us transmural injxn/mark","code_information":[{"code":"43253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd endo mucosal resection","code_information":[{"code":"43254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd control bleeding any","code_information":[{"code":"43255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd us exam duodenum/jejunum","code_information":[{"code":"43259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Ercp sphincter pressure meas","code_information":[{"code":"43263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd lesion ablation","code_information":[{"code":"43270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Ercp remove forgn body duct","code_information":[{"code":"43275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx trnsorl dplmnt balo","code_information":[{"code":"43290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Dilate esophagus","code_information":[{"code":"43453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube","code_information":[{"code":"43830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Open bowel to skin","code_information":[{"code":"44300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy/biopsy","code_information":[{"code":"44377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy br/wa","code_information":[{"code":"44381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Small bowel endoscopy","code_information":[{"code":"44384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Exchange drainage catheter","code_information":[{"code":"49423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Embedded IP Cath Exit-Site","code_information":[{"code":"49436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Place gastrostomy tube perc","code_information":[{"code":"49440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Place duod/jej tube perc","code_information":[{"code":"49441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Change g-tube to g-j perc","code_information":[{"code":"49446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1903.68,"maximum":3996.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2144.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2063.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1903.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2003.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2084.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2228.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3996.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2124.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2104.07,"additional_payer_notes":"APC"}]}]},{"description":"Egd flx transnasal tube/cath","code_information":[{"code":"0654T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy rigid balloon","code_information":[{"code":"43195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Esophagoscopy lesion ablate","code_information":[{"code":"43229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Egd w/thrml txmnt gerd","code_information":[{"code":"43257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Ercp w/specimen collection","code_information":[{"code":"43260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Endo cholangiopancreatograph","code_information":[{"code":"43261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Endo cholangiopancreatograph","code_information":[{"code":"43262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Ercp remove duct calculi","code_information":[{"code":"43264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Ercp ea duct/ampulla dilate","code_information":[{"code":"43277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Ercp lesion ablate w/dilate","code_information":[{"code":"43278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Lap rmvl gastr adj device","code_information":[{"code":"43772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Lap rmvl gastr adj all parts","code_information":[{"code":"43774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Repair of stomach lesion","code_information":[{"code":"43840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Repair stomach opening","code_information":[{"code":"43870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Suture small intestine","code_information":[{"code":"44602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Esophag mucosal integ add-on","code_information":[{"code":"C9777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"ESD endoscopy or colonoscopy","code_information":[{"code":"C9779","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3824.88,"maximum":8029.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4308.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4146.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3824.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4026.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4187.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4477.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8029.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4267.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4227.5,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy of bowel pouch","code_information":[{"code":"44385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy bowel pouch/biop","code_information":[{"code":"44386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy thru stoma spx","code_information":[{"code":"44388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy for foreign body","code_information":[{"code":"44390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"44408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy dx","code_information":[{"code":"45300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic sigmoidoscopy","code_information":[{"code":"45330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy and biopsy","code_information":[{"code":"45331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy & polypectomy","code_information":[{"code":"45333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/submuc inj","code_information":[{"code":"45335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy & decompress","code_information":[{"code":"45337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy W/Ultrasound","code_information":[{"code":"45341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic colonoscopy","code_information":[{"code":"45378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted procedure colon","code_information":[{"code":"45399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of rectal prolapse","code_information":[{"code":"45520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Reduction of rectal prolapse","code_information":[{"code":"45900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Rectum surgery procedure","code_information":[{"code":"45999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal abscess","code_information":[{"code":"46050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Ligation of hemorrhoid(s)","code_information":[{"code":"46221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Injection into hemorrhoid(s)","code_information":[{"code":"46500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove for body","code_information":[{"code":"46608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy","code_information":[{"code":"46611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46942","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Anus surgery procedure","code_information":[{"code":"46999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Gi trc img intral colon i&r","code_information":[{"code":"91113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Place endorectal app","code_information":[{"code":"C9725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"CA screen;flexi sigmoidscope","code_information":[{"code":"G0104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Colorectal scrn; hi risk ind","code_information":[{"code":"G0105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Colon ca scrn not hi rsk ind","code_information":[{"code":"G0121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Fecal microbiota prep instil","code_information":[{"code":"G0455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":922.58,"maximum":1936.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1039.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":922.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":971.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1009.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1079.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1936.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1029.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1019.69,"additional_payer_notes":"APC"}]}]},{"description":"Anosc sbmcsl njx bulking agt","code_information":[{"code":"0963T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Tranal ins tmp clrc anst dev","code_information":[{"code":"0967T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy with biopsy","code_information":[{"code":"44389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy for bleeding","code_information":[{"code":"44391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy & polypectomy","code_information":[{"code":"44392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/snare","code_information":[{"code":"44394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy with ablation","code_information":[{"code":"44401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"44403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/injection","code_information":[{"code":"44404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/dilation","code_information":[{"code":"44405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ultrasound","code_information":[{"code":"44406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ndl aspir/bx","code_information":[{"code":"44407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic abscess","code_information":[{"code":"45000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Excision of rectal stricture","code_information":[{"code":"45150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy dilate","code_information":[{"code":"45303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy w/bx","code_information":[{"code":"45305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy bleed","code_information":[{"code":"45317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/fb removal","code_information":[{"code":"45332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy for bleeding","code_information":[{"code":"45334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/tumr remove","code_information":[{"code":"45338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Sig w/tndsc balloon dilation","code_information":[{"code":"45340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy W/Us Guide Bx","code_information":[{"code":"45342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/ablation","code_information":[{"code":"45346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Sgmdsc w/band ligation","code_information":[{"code":"45350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/fb removal","code_information":[{"code":"45379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy and biopsy","code_information":[{"code":"45380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy submucous njx","code_information":[{"code":"45381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/control bleed","code_information":[{"code":"45382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/lesion removal","code_information":[{"code":"45385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/balloon dilat","code_information":[{"code":"45386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/ablation","code_information":[{"code":"45388","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/endoscope us","code_information":[{"code":"45391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/endoscopic fnb","code_information":[{"code":"45392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/decompression","code_information":[{"code":"45393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/band ligation","code_information":[{"code":"45398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of anal sphincter","code_information":[{"code":"45905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of rectal narrowing","code_information":[{"code":"45910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Remove rectal obstruction","code_information":[{"code":"45915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Removal of rectal marker","code_information":[{"code":"46030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Excise anal ext tag/papilla","code_information":[{"code":"46220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hemorrhoid clot","code_information":[{"code":"46320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenervation anal musc","code_information":[{"code":"46505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy and dilation","code_information":[{"code":"46604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy and biopsy","code_information":[{"code":"46606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy & biopsy","code_information":[{"code":"46607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy control bleeding","code_information":[{"code":"46614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Destroy internal hemorrhoids","code_information":[{"code":"46930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Place cecostomy tube perc","code_information":[{"code":"49442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1187.15,"maximum":2492.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1337.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1249.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1299.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2492.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1324.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1312.11,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of rectal abscess","code_information":[{"code":"45020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy of rectum","code_information":[{"code":"45100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anorectal lesion","code_information":[{"code":"45108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Excision of rectal lesion","code_information":[{"code":"45160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Exc rect tum transanal part","code_information":[{"code":"45171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Exc rect tum transanal full","code_information":[{"code":"45172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Destruction rectal tumor","code_information":[{"code":"45190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy fb","code_information":[{"code":"45307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy removal","code_information":[{"code":"45308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy ablate","code_information":[{"code":"45320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Proctosigmoidoscopy volvul","code_information":[{"code":"45321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Sigmoidoscopy w/resection","code_information":[{"code":"45349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Colonoscopy w/resection","code_information":[{"code":"45390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectum","code_information":[{"code":"45500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectum","code_information":[{"code":"45505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Correct rectal prolapse","code_information":[{"code":"45541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair of rectocele","code_information":[{"code":"45560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Surg dx exam anorectal","code_information":[{"code":"45990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Placement of seton","code_information":[{"code":"46020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Incision of rectal abscess","code_information":[{"code":"46060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal septum","code_information":[{"code":"46070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Incision of anal sphincter","code_information":[{"code":"46080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anal fissure","code_information":[{"code":"46200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Removal of anal tags","code_information":[{"code":"46230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove ext hem groups 2+","code_information":[{"code":"46250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove int/ext hem 1 group","code_information":[{"code":"46255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grp & fiss","code_information":[{"code":"46257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grp w/fistu","code_information":[{"code":"46258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem groups 2+","code_information":[{"code":"46260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grps & fiss","code_information":[{"code":"46261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove in/ex hem grps w/fist","code_information":[{"code":"46262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist subq","code_information":[{"code":"46270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist inter","code_information":[{"code":"46275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist complex","code_information":[{"code":"46280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove anal fist 2 stage","code_information":[{"code":"46285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair anal fistula","code_information":[{"code":"46288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove lesion","code_information":[{"code":"46610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy remove lesions","code_information":[{"code":"46612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Anoscopy","code_information":[{"code":"46615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal stricture","code_information":[{"code":"46700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repr of anal fistula w/glue","code_information":[{"code":"46706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair anorectal fist w/plug","code_information":[{"code":"46707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Reconstruction of anus","code_information":[{"code":"46753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Removal of suture from anus","code_information":[{"code":"46754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Repair of anal sphincter","code_information":[{"code":"46761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Laser surgery anal lesions","code_information":[{"code":"46917","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Excision of anal lesion(s)","code_information":[{"code":"46922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Destruction anal lesion(s)","code_information":[{"code":"46924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of anal fissure","code_information":[{"code":"46940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove by ligat int hem grp","code_information":[{"code":"46945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Remove by ligat int hem grps","code_information":[{"code":"46946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Hemorrhoidopexy by stapling","code_information":[{"code":"46947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Int hrhc tranal dartlzj 2+","code_information":[{"code":"46948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Rpr intst excl anrect fist","code_information":[{"code":"C9796","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2753.64,"maximum":5780.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3101.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2898.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3014.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3223.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5780.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3072.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3043.49,"additional_payer_notes":"APC"}]}]},{"description":"Insert pleural cath","code_information":[{"code":"32550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Incision of gallbladder","code_information":[{"code":"47490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Injection for cholangiogram","code_information":[{"code":"47531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Injection for cholangiogram","code_information":[{"code":"47532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Plmt biliary drainage cath","code_information":[{"code":"47533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Plmt biliary drainage cath","code_information":[{"code":"47534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Conversion ext bil drg cath","code_information":[{"code":"47535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Exchange biliary drg cath","code_information":[{"code":"47536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Excision of umbilicus","code_information":[{"code":"49250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body adbomen","code_information":[{"code":"49402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Insert tun ip cath perc","code_information":[{"code":"49418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Ins tun ip cath for dial opn","code_information":[{"code":"49421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Revise abdomen-venous shunt","code_information":[{"code":"49426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hern premie blocked","code_information":[{"code":"49492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia baby reduc","code_information":[{"code":"49495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia baby blocked","code_information":[{"code":"49496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia init blocked","code_information":[{"code":"49501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Prp i/hern init reduc >5 yr","code_information":[{"code":"49505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Prp i/hern init block >5 yr","code_information":[{"code":"49507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair ing hernia reduce","code_information":[{"code":"49520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Repair ing hernia sliding","code_information":[{"code":"49525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr rem hernia init reduce","code_information":[{"code":"49550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr fem hernia init blocked","code_information":[{"code":"49553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair fem hernia reduce","code_information":[{"code":"49555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair fem hernia blocked","code_information":[{"code":"49557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st < 3 cm rdc","code_information":[{"code":"49591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Repair umbilical lesion","code_information":[{"code":"49600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr < 3 rdc","code_information":[{"code":"49613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Removal of testis","code_information":[{"code":"54530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Exploration for testis","code_information":[{"code":"54550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Suspension of testis","code_information":[{"code":"54640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Orchiopexy (Fowler-Stephens)","code_information":[{"code":"54650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydrocele","code_information":[{"code":"55040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Removal of hydroceles","code_information":[{"code":"55041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Revise hernia & sperm veins","code_information":[{"code":"55540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3551.99,"maximum":7456.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4000.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3851.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3551.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3738.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3888.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4157.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7456.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3963.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3925.88,"additional_payer_notes":"APC"}]}]},{"description":"Appendectomy","code_information":[{"code":"44950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Plmt access bil tree sm bwl","code_information":[{"code":"47541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endo perq dx w/speci","code_information":[{"code":"47552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Biliary endoscopy thru skin","code_information":[{"code":"47555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Exploration behind abdomen","code_information":[{"code":"49010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Removal of omentum","code_information":[{"code":"49255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Rpr ing hernia init reduce","code_information":[{"code":"49500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Rerepair ing hernia blocked","code_information":[{"code":"49521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st 3-10 rdc","code_information":[{"code":"49593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st > 10 rdc","code_information":[{"code":"49595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr 3-10 rdc","code_information":[{"code":"49615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Revise spermatic cord veins","code_information":[{"code":"55535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Inst pleu-perit shnt w pump","code_information":[{"code":"C8006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6422.45,"maximum":13482.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7233.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6963.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6422.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6760.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7030.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7517.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13482.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7166.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7098.5,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy diagnostic","code_information":[{"code":"32601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx med space","code_information":[{"code":"32606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Thoracoscopy w/bx pleura","code_information":[{"code":"32609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Perq rf ablate tx pul tumor","code_information":[{"code":"32998","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc spleen","code_information":[{"code":"38129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Explore deep node(s) neck","code_information":[{"code":"38542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lymph node biop","code_information":[{"code":"38570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc lymphatic","code_information":[{"code":"38589","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Remove armpit lymph nodes","code_information":[{"code":"38740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Remove armpit lymph nodes","code_information":[{"code":"38745","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Mediastinoscpy w/medstnl bx","code_information":[{"code":"39401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Mediastinoscpy w/lmph nod bx","code_information":[{"code":"39402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl esophgl sphnctr dev","code_information":[{"code":"43285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc esoph","code_information":[{"code":"43289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy vagus nerve","code_information":[{"code":"43651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy vagus nerve","code_information":[{"code":"43652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy gastrostomy","code_information":[{"code":"43653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc stom","code_information":[{"code":"43659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Lap replace gastr adj device","code_information":[{"code":"43773","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Lap enterolysis","code_information":[{"code":"44180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Lap jejunostomy","code_information":[{"code":"44186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc intestine","code_information":[{"code":"44238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy appendectomy","code_information":[{"code":"44970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc app","code_information":[{"code":"44979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc rectum","code_information":[{"code":"45499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope procedure liver","code_information":[{"code":"47379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Percut ablate liver rf","code_information":[{"code":"47382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Perq plmt bile duct stent","code_information":[{"code":"47540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic cholecystectomy","code_information":[{"code":"47562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo cholecystectomy/graph","code_information":[{"code":"47563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc biliary","code_information":[{"code":"47579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Diag laparo separate proc","code_information":[{"code":"49320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy biopsy","code_information":[{"code":"49321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy aspiration","code_information":[{"code":"49322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo drain lymphocele","code_information":[{"code":"49323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Lap insert tunnel ip cath","code_information":[{"code":"49324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Lap Revision Perm IP Cath","code_information":[{"code":"49325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc abdm/per/oment","code_information":[{"code":"49329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr hern preemie reduc","code_information":[{"code":"49491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Repair lumbar hernia","code_information":[{"code":"49540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st < 3 ncr/strn","code_information":[{"code":"49592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn 1st 3-10 ncr/strn","code_information":[{"code":"49594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Rpr aa hrn rcr < 3 ncr/strn","code_information":[{"code":"49614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Lap ing hernia repair init","code_information":[{"code":"49650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Lap ing hernia repair recur","code_information":[{"code":"49651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc hernia repair","code_information":[{"code":"49659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc renal","code_information":[{"code":"50549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Perc rf ablate renal tumor","code_information":[{"code":"50592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy ureterolithotomy","code_information":[{"code":"50945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc ureter","code_information":[{"code":"50949","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Removal of bladder cyst","code_information":[{"code":"51500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo urethral suspension","code_information":[{"code":"51990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo sling operation","code_information":[{"code":"51992","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc bla","code_information":[{"code":"51999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy orchiectomy","code_information":[{"code":"54690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy orchiopexy","code_information":[{"code":"54692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscope proc testis","code_information":[{"code":"54699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo ligate spermatic vein","code_information":[{"code":"55550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc spermatic cord","code_information":[{"code":"55559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopic myomectomy","code_information":[{"code":"58545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo-asst vag hysterectomy","code_information":[{"code":"58550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc uterus","code_information":[{"code":"58578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy lysis","code_information":[{"code":"58660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy remove adnexa","code_information":[{"code":"58661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy excise lesions","code_information":[{"code":"58662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy tubal cautery","code_information":[{"code":"58670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy tubal block","code_information":[{"code":"58671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparoscopy fimbrioplasty","code_information":[{"code":"58672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc oviduct-ovary","code_information":[{"code":"58679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Treat ectopic pregnancy","code_information":[{"code":"59151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc ob care/deliver","code_information":[{"code":"59898","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid lesion","code_information":[{"code":"60200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Partial thyroid excision","code_information":[{"code":"60210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Partial thyroid excision","code_information":[{"code":"60212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of thyroid","code_information":[{"code":"60220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Partial removal of thyroid","code_information":[{"code":"60225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Removal of thyroid","code_information":[{"code":"60240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid duct lesion","code_information":[{"code":"60280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Remove thyroid duct lesion","code_information":[{"code":"60281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Laparo proc endocrine","code_information":[{"code":"60659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Endocrine surgery procedure","code_information":[{"code":"60699","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5997.56,"maximum":12590.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6755.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6502.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5997.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6313.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6565.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7020.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12590.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6692.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6628.88,"additional_payer_notes":"APC"}]}]},{"description":"Low ntsty eswt corpus cvrnsm","code_information":[{"code":"0864T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Reposition gastrostomy tube","code_information":[{"code":"43761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Rplc gtube no revj trc","code_information":[{"code":"43762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Rplc gtube  revj gstrst trc","code_information":[{"code":"43763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Incise external hemorrhoid","code_information":[{"code":"46083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Instll rx agnt into rnal tub","code_information":[{"code":"50391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Drain bladder by needle","code_information":[{"code":"51100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Irrigation of bladder","code_information":[{"code":"51700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Change of bladder tube","code_information":[{"code":"51705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Simple cystometrogram","code_information":[{"code":"51725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Complex cystometrogram","code_information":[{"code":"51726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Anal/urinary muscle study","code_information":[{"code":"51785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Tprnl balo cntnc dev adjmt","code_information":[{"code":"53454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Cathj rmvl dev ischmc rmdlg","code_information":[{"code":"53866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Urology surgery procedure","code_information":[{"code":"53899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Treatment of penis lesion","code_information":[{"code":"54220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Dynamic cavernosometry","code_information":[{"code":"54231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Penile injection","code_information":[{"code":"54235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Penis study","code_information":[{"code":"54250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Preputial stretching","code_information":[{"code":"54450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Genital surgery procedure","code_information":[{"code":"55899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.87,"maximum":520.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.96,"additional_payer_notes":"APC"}]}]},{"description":"Attach bladder/urethra","code_information":[{"code":"51840","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder neck","code_information":[{"code":"51845","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Place needles pelvic for rt","code_information":[{"code":"55920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Sex transformation m to f","code_information":[{"code":"55970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Extensive vulva surgery","code_information":[{"code":"56630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of pelvic fluid","code_information":[{"code":"57020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Closure of vagina","code_information":[{"code":"57120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Insert uteri tandem/ovoids","code_information":[{"code":"57155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Revision of urethra","code_information":[{"code":"57220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder & vagina","code_information":[{"code":"57240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair rectum & vagina","code_information":[{"code":"57250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair of vagina","code_information":[{"code":"57260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Extensive repair of vagina","code_information":[{"code":"57265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair of bowel bulge","code_information":[{"code":"57268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair paravag defect open","code_information":[{"code":"57284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder defect","code_information":[{"code":"57288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Construction of vagina","code_information":[{"code":"57291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Construct vagina with graft","code_information":[{"code":"57292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair bladder-vagina lesion","code_information":[{"code":"57320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Repair vagina","code_information":[{"code":"57335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of cervix","code_information":[{"code":"57530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of residual cervix","code_information":[{"code":"57550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove cervix/repair vagina","code_information":[{"code":"57555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove cervix repair bowel","code_information":[{"code":"57556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Vaginal hysterectomy","code_information":[{"code":"58260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst including t/o","code_information":[{"code":"58262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/t/o & vag repair","code_information":[{"code":"58263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/enterocele repair","code_information":[{"code":"58270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst incl t/o complex","code_information":[{"code":"58291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Vag hyst w/enterocele compl","code_information":[{"code":"58294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Insert heyman uteri capsule","code_information":[{"code":"58346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Reopen fallopian tube","code_information":[{"code":"58350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Endometr ablate thermal","code_information":[{"code":"58353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Endometrial cryoablation","code_information":[{"code":"58356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy lysis","code_information":[{"code":"58559","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy resect septum","code_information":[{"code":"58560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy remove myoma","code_information":[{"code":"58561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy ablation","code_information":[{"code":"58563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Hysteroscopy sterilization","code_information":[{"code":"58565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Removal of ovarian cyst(s)","code_information":[{"code":"58925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Remove uterus lesion","code_information":[{"code":"59100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Colpopexy, min/inv, ex-perit","code_information":[{"code":"C9778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4962.76,"maximum":10418.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5589.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5380.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4962.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5223.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5432.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10418.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5537.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.15,"additional_payer_notes":"APC"}]}]},{"description":"Drain/inj joint/bursa w/us","code_information":[{"code":"20606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Remove cranial cavity fluid","code_information":[{"code":"61001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Injection into brain canal","code_information":[{"code":"61026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Brain canal shunt procedure","code_information":[{"code":"61070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Spinal fluid tap diagnostic","code_information":[{"code":"62270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Drain cerebro spinal fluid","code_information":[{"code":"62272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Inject epidural patch","code_information":[{"code":"62273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar crv/thrc","code_information":[{"code":"62321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Njx interlaminar lmbr/sac","code_information":[{"code":"62323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Dx lmbr spi pnxr w/fluor/ct","code_information":[{"code":"62328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Ther spi pnxr csf fluor/ct","code_information":[{"code":"62329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"N block inj suprascapular","code_information":[{"code":"64418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"N block inj intercost sng","code_information":[{"code":"64420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"N block inj ilio-ing/hypogi","code_information":[{"code":"64425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"N block inj paracervical","code_information":[{"code":"64435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"N block inj sciatic sng","code_information":[{"code":"64445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"N block inj fem single","code_information":[{"code":"64447","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"N block other peripheral","code_information":[{"code":"64450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Njx aa&/strd nrv nrvtg si jt","code_information":[{"code":"64451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Njx aa&/strd gnclr nrv brnch","code_information":[{"code":"64454","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Pvb thoracic single inj site","code_information":[{"code":"64461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Pvb thoracic cont infusion","code_information":[{"code":"64463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemodener muscle larynx emg","code_information":[{"code":"64617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extremity 1-4","code_information":[{"code":"64642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv 1 extrem 5/> mus","code_information":[{"code":"64644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv trunk musc 1-5","code_information":[{"code":"64646","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Chemodenerv trunk musc 6/>","code_information":[{"code":"64647","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Inj for sacroiliac jt anesth","code_information":[{"code":"G0260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":700.28,"maximum":1470.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":788.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":737.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":766.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":819.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1470.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":773.99,"additional_payer_notes":"APC"}]}]},{"description":"Revision/removal isdns ptn","code_information":[{"code":"0588T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Rlcj pulse gen only isdss","code_information":[{"code":"0681T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Removal pulse gen only isdss","code_information":[{"code":"0682T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea spi w/nstim","code_information":[{"code":"0785T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea sac w/nstim","code_information":[{"code":"0787T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq","code_information":[{"code":"0818T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subf","code_information":[{"code":"0819T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl int nstim sys vagus nrv","code_information":[{"code":"0910T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl ins ptn subq&subf","code_information":[{"code":"0989T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Rev/rmv lw esoph sphnc npg/r","code_information":[{"code":"1015T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim sys","code_information":[{"code":"33278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim transvns","code_information":[{"code":"33279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl phrnc nrv stim pg only","code_information":[{"code":"33280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Reposg phrnc nrv stim trnsvn","code_information":[{"code":"33281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroelectrode","code_information":[{"code":"61880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Remove spine eltrd plate","code_information":[{"code":"63662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroreceiver","code_information":[{"code":"63688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revise/remove neuroelectrode","code_information":[{"code":"64585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revise/rmv pn/gastr stimul","code_information":[{"code":"64595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rmvl nea pn w/int nstim","code_information":[{"code":"64598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Revj/rplcmt bat mod sys lead","code_information":[{"code":"64655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modul sys lead only","code_information":[{"code":"64658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Rmvl bat modulj sys pg only","code_information":[{"code":"64659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3468.36,"maximum":7281.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3906.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3760.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3468.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3650.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3796.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4059.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7281.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3869.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3833.46,"additional_payer_notes":"APC"}]}]},{"description":"Insj/rplcmt pg only isdss","code_information":[{"code":"0680T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19246.18,"maximum":40402.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21677.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20866.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19246.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22528.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40402.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21474.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.09,"additional_payer_notes":"APC"}]}]},{"description":"Opn insj/rplcmt ins ptn subq","code_information":[{"code":"0816T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19246.18,"maximum":40402.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21677.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20866.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19246.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22528.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40402.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21474.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.09,"additional_payer_notes":"APC"}]}]},{"description":"Opn insj/rplcmt ins ptn subf","code_information":[{"code":"0817T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19246.18,"maximum":40402.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21677.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20866.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19246.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22528.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40402.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21474.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.09,"additional_payer_notes":"APC"}]}]},{"description":"Lap srg imp/rpl eso nea&pg/r","code_information":[{"code":"1013T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19246.18,"maximum":40402.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21677.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20866.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19246.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22528.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40402.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21474.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.09,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"63655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19246.18,"maximum":40402.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21677.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20866.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19246.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22528.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40402.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21474.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.09,"additional_payer_notes":"APC"}]}]},{"description":"Implant neuroelectrodes","code_information":[{"code":"64580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19246.18,"maximum":40402.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21677.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20866.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19246.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22528.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40402.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21474.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.09,"additional_payer_notes":"APC"}]}]},{"description":"Insrt/redo pn/gastr stimul","code_information":[{"code":"64590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19246.18,"maximum":40402.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21677.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20866.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19246.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21069.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22528.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40402.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21474.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21272.09,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral periapical first","code_information":[{"code":"D0220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral occlusal film","code_information":[{"code":"D0240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Extraoral 2d project image","code_information":[{"code":"D0250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Extraoral posterior image","code_information":[{"code":"D0251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Dental bitewing single image","code_information":[{"code":"D0270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Dental bitewings two images","code_information":[{"code":"D0272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Other tmj images by report","code_information":[{"code":"D0321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"2d cephalometric image","code_information":[{"code":"D0340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Oral/facial photo images","code_information":[{"code":"D0350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Sialoendoscopy capt & interp","code_information":[{"code":"D0371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Trtmnt simulation 3d image","code_information":[{"code":"D0393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Digital sub 2 or more images","code_information":[{"code":"D0394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Fusion 2 or more 3d images","code_information":[{"code":"D0395","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=61.50","code_information":[{"code":"D0701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=52.50 and M <61.50","code_information":[{"code":"D0702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Fracture of lower extremity M >=41.50 and M <52.50","code_information":[{"code":"D0703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Extra oral post radio image","code_information":[{"code":"D0705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral occlus radio image","code_information":[{"code":"D0706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral periap radio image","code_information":[{"code":"D0707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral bite radio image","code_information":[{"code":"D0708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Intraoral cmplt radio images","code_information":[{"code":"D0709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Software meas of cardiac vol","code_information":[{"code":"G0183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.33,"maximum":181.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.42,"additional_payer_notes":"APC"}]}]},{"description":"Extracranial uni/ltd study","code_information":[{"code":"93882","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial limited study","code_information":[{"code":"93888","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Tcd emboli detect w/o inj","code_information":[{"code":"93892","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Tcd emboli detect w/inj","code_information":[{"code":"93893","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Lower extremity study","code_information":[{"code":"93926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity study","code_information":[{"code":"93931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Extremity study","code_information":[{"code":"93971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93976","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Penile vascular study","code_information":[{"code":"93980","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Penile vascular study","code_information":[{"code":"93981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Dup-scan hemo compl uni std","code_information":[{"code":"93986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Doppler flow testing","code_information":[{"code":"93990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Dental tomographic survey","code_information":[{"code":"D0322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt & interp","code_information":[{"code":"D0364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete man","code_information":[{"code":"D0365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete max","code_information":[{"code":"D0366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interp both jaw","code_information":[{"code":"D0367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct interprete TMJ","code_information":[{"code":"D0368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Max MRI capture & interprete","code_information":[{"code":"D0369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Max ultrasound capt & interp","code_information":[{"code":"D0370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capture limited","code_information":[{"code":"D0380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt mandible","code_information":[{"code":"D0381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capt maxilla","code_information":[{"code":"D0382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct both jaws","code_information":[{"code":"D0383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Cone beam ct capture TMJ","code_information":[{"code":"D0384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Max MRI image capture","code_information":[{"code":"D0385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"Max ultrasound image capture","code_information":[{"code":"D0386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.72,"maximum":217.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.63,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt car rsk w/o ct","code_information":[{"code":"0992T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt car rsk w/ct","code_information":[{"code":"0993T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Fluoro exam of g/colon tube","code_information":[{"code":"49465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Tte w/o doppler complete","code_information":[{"code":"93307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Tte f-up or lmtd","code_information":[{"code":"93308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Extracranial bilat study","code_information":[{"code":"93880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Intracranial complete study","code_information":[{"code":"93886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Lower extremity study","code_information":[{"code":"93925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Upper extremity study","code_information":[{"code":"93930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Extremity study","code_information":[{"code":"93970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93975","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Vascular study","code_information":[{"code":"93978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Dup-scan hemo compl bi std","code_information":[{"code":"93985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Intraor complete film series","code_information":[{"code":"D0210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Bitewings - three images","code_information":[{"code":"D0273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Bitewings four images","code_information":[{"code":"D0274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Vert bitewings 7 to 8 images","code_information":[{"code":"D0277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Dental saliography","code_information":[{"code":"D0310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Dental tmj arthrogram incl i","code_information":[{"code":"D0320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Panoramic image","code_information":[{"code":"D0330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.71,"maximum":496.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":266.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":277.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":496.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":261.63,"additional_payer_notes":"APC"}]}]},{"description":"Echo transthoracic","code_information":[{"code":"93303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Echo transthoracic","code_information":[{"code":"93304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Tte w/doppler complete","code_information":[{"code":"93306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Echo transesophageal","code_information":[{"code":"93316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Echo Transesophageal Intraop","code_information":[{"code":"93318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Stress tte only","code_information":[{"code":"93350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Stress tte complete","code_information":[{"code":"93351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":542.08,"maximum":1137.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":610.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":587.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":593.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1137.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":604.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":599.14,"additional_payer_notes":"APC"}]}]},{"description":"Ct cere prfu aly c+wo ct/cta","code_information":[{"code":"70473","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":174.01,"maximum":365.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":195.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":365.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":192.33,"additional_payer_notes":"APC"}]}]},{"description":"Cta h&n c+ w/noncontrast img","code_information":[{"code":"70471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"}]}]},{"description":"2d tte w or w/o fol w/con,fu","code_information":[{"code":"C8924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":346.11,"maximum":726.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":389.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":346.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":378.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":726.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.54,"additional_payer_notes":"APC"}]}]},{"description":"Alt elec fld dos&dlv sim mdl","code_information":[{"code":"1025T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Set radiation therapy field","code_information":[{"code":"77280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Radiation therapy planning","code_information":[{"code":"77299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Radiation therapy dose plan","code_information":[{"code":"77300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Special radiation dosimetry","code_information":[{"code":"77331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment aid(s)","code_information":[{"code":"77332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment aid(s)","code_information":[{"code":"77333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Radiation physics consult","code_information":[{"code":"77336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Radiation physics consult","code_information":[{"code":"77370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"External radiation dosimetry","code_information":[{"code":"77399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.34,"maximum":279.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":279.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.38,"additional_payer_notes":"APC"}]}]},{"description":"Set radiation therapy field","code_information":[{"code":"77285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Set radiation therapy field","code_information":[{"code":"77290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Telethx isodose plan simple","code_information":[{"code":"77306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Telethx isodose plan cplx","code_information":[{"code":"77307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Brachytx isodose plan simple","code_information":[{"code":"77316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Brachytx isodose intermed","code_information":[{"code":"77317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Brachytx isodose complex","code_information":[{"code":"77318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Special teletx port plan","code_information":[{"code":"77321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment aid(s)","code_information":[{"code":"77334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Design mlc device for imrt","code_information":[{"code":"77338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.46,"maximum":779.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.56,"additional_payer_notes":"APC"}]}]},{"description":"Ins mark thor for rt perq","code_information":[{"code":"32553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.15,"maximum":2882.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1546.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1488.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1373.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1445.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1607.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2882.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1532.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1517.69,"additional_payer_notes":"APC"}]}]},{"description":"Ins mark abd/pel for rt perq","code_information":[{"code":"49411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.15,"maximum":2882.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1546.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1488.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1373.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1445.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1607.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2882.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1532.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1517.69,"additional_payer_notes":"APC"}]}]},{"description":"Place rt device/marker pros","code_information":[{"code":"55876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.15,"maximum":2882.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1546.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1488.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1373.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1445.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1607.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2882.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1532.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1517.69,"additional_payer_notes":"APC"}]}]},{"description":"3-d radiotherapy plan","code_information":[{"code":"77295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.15,"maximum":2882.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1546.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1488.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1373.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1445.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1607.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2882.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1532.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1517.69,"additional_payer_notes":"APC"}]}]},{"description":"Radiotherapy dose plan imrt","code_information":[{"code":"77301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.15,"maximum":2882.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1546.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1488.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1373.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1445.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1607.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2882.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1532.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1517.69,"additional_payer_notes":"APC"}]}]},{"description":"Place device/marker, non pro","code_information":[{"code":"C9728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1373.15,"maximum":2882.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1546.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1488.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1373.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1445.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1607.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2882.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1532.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1517.69,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment delivery","code_information":[{"code":"77402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.22,"maximum":212.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":212.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111.88,"additional_payer_notes":"APC"}]}]},{"description":"Surf radj ther supfc<=150kv","code_information":[{"code":"77437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.22,"maximum":212.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":212.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111.88,"additional_payer_notes":"APC"}]}]},{"description":"Surf rad thr orthvlt>150-500","code_information":[{"code":"77438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.22,"maximum":212.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":212.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111.88,"additional_payer_notes":"APC"}]}]},{"description":"Apply surf ldr radionuclide","code_information":[{"code":"77789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.22,"maximum":212.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":212.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111.88,"additional_payer_notes":"APC"}]}]},{"description":"Radium/radioisotope therapy","code_information":[{"code":"77799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.22,"maximum":212.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":212.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111.88,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment delivery","code_information":[{"code":"77407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.64,"maximum":803.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":418.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":447.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":803.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":426.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":422.91,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.64,"maximum":803.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":418.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":447.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":803.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":426.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":422.91,"additional_payer_notes":"APC"}]}]},{"description":"Infuse radioactive materials","code_information":[{"code":"77750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.64,"maximum":803.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":418.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":447.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":803.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":426.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":422.91,"additional_payer_notes":"APC"}]}]},{"description":"Hdr rdncl skn surf brachytx","code_information":[{"code":"77767","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.64,"maximum":803.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":418.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":447.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":803.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":426.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":422.91,"additional_payer_notes":"APC"}]}]},{"description":"Hdr rdncl skn surf brachytx","code_information":[{"code":"77768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.64,"maximum":803.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":418.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":447.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":803.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":426.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":422.91,"additional_payer_notes":"APC"}]}]},{"description":"Radiation treatment delivery","code_information":[{"code":"77412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"Neutron beam tx complex","code_information":[{"code":"77423","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"Special radiation treatment","code_information":[{"code":"77470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"Proton trmt simple w/o comp","code_information":[{"code":"77520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"Hyperthermia treatment","code_information":[{"code":"77620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"Apply intrcav radiat simple","code_information":[{"code":"77761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"Apply intrcav radiat interm","code_information":[{"code":"77762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":548.16,"maximum":1150.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":617.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1150.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":611.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":605.86,"additional_payer_notes":"APC"}]}]},{"description":"SBRT Delivery","code_information":[{"code":"77373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1773.86,"maximum":3723.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1997.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1923.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1773.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1867.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1941.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2076.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3723.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1979.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1960.59,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj sf 5-20","code_information":[{"code":"80503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv authrj","code_information":[{"code":"86079","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody screen","code_information":[{"code":"86850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath cell enhance tech","code_information":[{"code":"88112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Forensic cytopathology","code_information":[{"code":"88125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath smear other source","code_information":[{"code":"88162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath eval fna report","code_information":[{"code":"88173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Cell marker study","code_information":[{"code":"88182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Cytopathology procedure","code_information":[{"code":"88199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetic study","code_information":[{"code":"88299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Special stains group 1","code_information":[{"code":"88312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Microslide consultation","code_information":[{"code":"88323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Analysis nerve","code_information":[{"code":"88356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Surgical pathology procedure","code_information":[{"code":"88399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Collect sweat for test","code_information":[{"code":"89230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Pathology lab procedure","code_information":[{"code":"89240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Prepare embryo for transfer","code_information":[{"code":"89255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Sperm identification","code_information":[{"code":"89257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Sperm isolation simple","code_information":[{"code":"89260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Sperm isolation complex","code_information":[{"code":"89261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Identify sperm tissue","code_information":[{"code":"89264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreserve testicular tiss","code_information":[{"code":"89335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved sperm","code_information":[{"code":"89353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Unlisted reprod med lab proc","code_information":[{"code":"89398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.70,"maximum":108.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.14,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj mod 21-40","code_information":[{"code":"80504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Path clin consltj high 41-60","code_information":[{"code":"80505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Phys blood bank serv reactj","code_information":[{"code":"86078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody elution","code_information":[{"code":"86860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test indirect qual","code_information":[{"code":"86885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test indirect titer","code_information":[{"code":"86886","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Autologous blood process","code_information":[{"code":"86890","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test spin","code_information":[{"code":"86920","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test incubate","code_information":[{"code":"86921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test antiglob","code_information":[{"code":"86922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Compatibility test electric","code_information":[{"code":"86923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Plasma fresh frozen","code_information":[{"code":"86927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood prep","code_information":[{"code":"86930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Frozen blood thaw","code_information":[{"code":"86931","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Leukacyte transfusion","code_information":[{"code":"86950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Vol reduction of blood/prod","code_information":[{"code":"86960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Pooling blood platelets","code_information":[{"code":"86965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/enzymes","code_information":[{"code":"86971","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/density","code_information":[{"code":"86972","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Rbc serum pretx incubj/inhib","code_information":[{"code":"86977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Split blood or products","code_information":[{"code":"86985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Cytp urne 3-5 probes ea spec","code_information":[{"code":"88120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Cytp urine 3-5 probes cmptr","code_information":[{"code":"88121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Cytp dx eval fna 1st ea site","code_information":[{"code":"88172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensive review of data","code_information":[{"code":"88325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Path consult intraop 1 bloc","code_information":[{"code":"88331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Immunohisto antb 1st stain","code_information":[{"code":"88342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Immunofluor antb 1st stain","code_information":[{"code":"88346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Analysis skeletal muscle","code_information":[{"code":"88355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Analysis tumor","code_information":[{"code":"88358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Tumor immunohistochem/manual","code_information":[{"code":"88360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization (fish)","code_information":[{"code":"88365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization (fish)","code_information":[{"code":"88366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"M/phmtrc alys ishquant/semiq","code_information":[{"code":"88374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"M/phmtrc alys ishquant/semiq","code_information":[{"code":"88377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Chct for mal hyperthermia","code_information":[{"code":"89049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Sputum specimen collection","code_information":[{"code":"89220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Cultr oocyte/embryo <4 days","code_information":[{"code":"89250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Cultr oocyte/embryo <4 days","code_information":[{"code":"89251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Embryo hatching","code_information":[{"code":"89253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Oocyte identification","code_information":[{"code":"89254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation sperm","code_information":[{"code":"89259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Insemination of oocytes","code_information":[{"code":"89268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Assist oocyte fertilization","code_information":[{"code":"89281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy oocyte polar body","code_information":[{"code":"89290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Biopsy oocyte polar body","code_information":[{"code":"89291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Cryopreservation oocyte(s)","code_information":[{"code":"89337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year embryo(s)","code_information":[{"code":"89342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year sperm/semen","code_information":[{"code":"89343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year reprod tissue","code_information":[{"code":"89344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Storage/year oocyte(s)","code_information":[{"code":"89346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved embryo","code_information":[{"code":"89352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Thaw cryoprsvrd reprod tiss","code_information":[{"code":"89354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"Thawing cryopresrved oocyte","code_information":[{"code":"89356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":169.02,"maximum":354.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":190.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.81,"additional_payer_notes":"APC"}]}]},{"description":"RBC antibody identification","code_information":[{"code":"86870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Blood type antigen donor ea","code_information":[{"code":"86902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing rbc antigens","code_information":[{"code":"86905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Flowcytometry/ tc 1 marker","code_information":[{"code":"88184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam by pathologist","code_information":[{"code":"88307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Immunohisto antibody slide","code_information":[{"code":"88344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Tumor immunohistochem/comput","code_information":[{"code":"88361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization auto","code_information":[{"code":"88367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Insitu hybridization manual","code_information":[{"code":"88368","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Prostate biopsy, any mthd","code_information":[{"code":"G0416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":355.60,"maximum":746.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":385.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":374.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":746.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.03,"additional_payer_notes":"APC"}]}]},{"description":"Inj w/fluor eval cv device","code_information":[{"code":"36598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Hydration iv infusion init","code_information":[{"code":"96360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag iv inf init","code_information":[{"code":"96365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Sc ther infusion up to 1 hr","code_information":[{"code":"96369","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj ia","code_information":[{"code":"96373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Ther/proph/diag inj iv push","code_information":[{"code":"96374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Chemo intralesional over 7","code_information":[{"code":"96406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Refill/maint portable pump","code_information":[{"code":"96521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Refill/maint pump/resvr syst","code_information":[{"code":"96522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Prolonged iv inf, req pump","code_information":[{"code":"C8957","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.02,"maximum":442.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":442.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.23,"additional_payer_notes":"APC"}]}]},{"description":"Declot vascular device","code_information":[{"code":"36593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Thrombolytic therapy stroke","code_information":[{"code":"37195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Car-t admn autologous","code_information":[{"code":"38228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Injection eye drug","code_information":[{"code":"67028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Sprchoroidal spc njx rx agt","code_information":[{"code":"67516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Spin/brain pump refil & main","code_information":[{"code":"95990","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv push sngl drug","code_information":[{"code":"96409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemo iv infusion 1 hr","code_information":[{"code":"96413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemo prolong infuse w/pump","code_information":[{"code":"96416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia push tecnique","code_information":[{"code":"96420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemo ia infusion up to 1 hr","code_information":[{"code":"96422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy infusion method","code_information":[{"code":"96425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy intracavitary","code_information":[{"code":"96440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemotx admn prtl cavity","code_information":[{"code":"96446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy into cns","code_information":[{"code":"96450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemotherapy injection","code_information":[{"code":"96542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Chemo extend iv infus w/pump","code_information":[{"code":"G0498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":327.68,"maximum":687.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":358.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":687.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":365.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.18,"additional_payer_notes":"APC"}]}]},{"description":"Compre audiometry evaluation","code_information":[{"code":"0212T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Tempr","code_information":[{"code":"0278T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Visual ep test for glaucoma","code_information":[{"code":"0464T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Colonic lavage 35+l water","code_information":[{"code":"0736T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Tc auriculr neurostimulation","code_information":[{"code":"0783T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Rem mlt day uroflow dev sply","code_information":[{"code":"0812T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Dx gastr intub w/asp specs","code_information":[{"code":"43755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Measure ureter pressure","code_information":[{"code":"50686","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Insert bladder cath complex","code_information":[{"code":"51703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Anal/urinary muscle study","code_information":[{"code":"51784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Gastroenterology procedure","code_information":[{"code":"91299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Multifocal erg w/i&r","code_information":[{"code":"92274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Vemp test i&r cervical","code_information":[{"code":"92517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Vemp test i&r ocular","code_information":[{"code":"92518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Caloric vstblr test w/rec","code_information":[{"code":"92537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Optokinetic nystagmus test","code_information":[{"code":"92544","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Sinusoidal rotational test","code_information":[{"code":"92546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Audiometry air & bone","code_information":[{"code":"92553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Comprehensive hearing test","code_information":[{"code":"92557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Acoustic immitance testing","code_information":[{"code":"92570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Staggered spondaic word test","code_information":[{"code":"92572","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Conditioning play audiometry","code_information":[{"code":"92582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Electrocochleography","code_information":[{"code":"92584","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Cochlear implt f/up exam <7","code_information":[{"code":"92601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Reprogram cochlear implt 7/>","code_information":[{"code":"92602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Cochlear implt f/up exam 7/>","code_information":[{"code":"92603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Reprogram cochlear implt 7/>","code_information":[{"code":"92604","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Auditory function 60 min","code_information":[{"code":"92620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Dx aly aud oi snd prcsr 1st","code_information":[{"code":"92622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Tinnitus assessment","code_information":[{"code":"92625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Eval aud rehab status","code_information":[{"code":"92626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Aud brainstem implt programg","code_information":[{"code":"92640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Microvolt t-wave assess","code_information":[{"code":"93025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Interrog crtd sins bat ip wo","code_information":[{"code":"93145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Interrog crtd sins bat ip w/","code_information":[{"code":"93146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Bis xtracell fluid analysis","code_information":[{"code":"93702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Temperature gradient studies","code_information":[{"code":"93740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular procedure","code_information":[{"code":"93799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Spirometry up to 2 yrs old","code_information":[{"code":"94011","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Vital capacity test","code_information":[{"code":"94150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Hypoxia response curve","code_information":[{"code":"94450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis o2","code_information":[{"code":"94680","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Pulm funct test oscillometry","code_information":[{"code":"94728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Measure blood oxygen level","code_information":[{"code":"94762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Ped home apnea rec hk-up","code_information":[{"code":"94775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Ped home apnea rec downld","code_information":[{"code":"94776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Pulmonary service/procedure","code_information":[{"code":"94799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 3 limbs","code_information":[{"code":"95863","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 4 limbs","code_information":[{"code":"95864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test hemidiaphragm","code_information":[{"code":"95866","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Limb exercise test","code_information":[{"code":"95875","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv parasym inervj","code_information":[{"code":"95921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Neuromuscular junction test","code_information":[{"code":"95937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Neurological procedure","code_information":[{"code":"95999","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Devel tst phys/qhp 1st hr","code_information":[{"code":"96112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.65,"maximum":267.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":141.09,"additional_payer_notes":"APC"}]}]},{"description":"Pattern erg w/i&r","code_information":[{"code":"0509T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"N-nvs artl plaq alys quan","code_information":[{"code":"0712T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Tc mag stimj pn 1st tx 1nrv","code_information":[{"code":"0766T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Tx gastro intub w/asp","code_information":[{"code":"43753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Dx gastr intub w/asp spec","code_information":[{"code":"43754","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Electro-uroflowmetry first","code_information":[{"code":"51741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Penis study","code_information":[{"code":"54240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Tcranial magn stim tx plan","code_information":[{"code":"90867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Tcranial magn stim tx deli","code_information":[{"code":"90868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Tcran magn stim redetemine","code_information":[{"code":"90869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Esoph imped function test","code_information":[{"code":"91037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Breath hydrogen/methane test","code_information":[{"code":"91065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Colon motility 6 hr study","code_information":[{"code":"91117","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Rct snsatn tone&cmplianc std","code_information":[{"code":"91124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Electrogastrography","code_information":[{"code":"91132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescein angrph uni/bi","code_information":[{"code":"92235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Icg angiography uni/bi","code_information":[{"code":"92240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescein icg angiography","code_information":[{"code":"92242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Full field erg w/i&r","code_information":[{"code":"92273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Nasal function studies","code_information":[{"code":"92512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Facial nerve function test","code_information":[{"code":"92516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Vemp tst i&r cervical&ocular","code_information":[{"code":"92519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Caloric vstblr test w/rec","code_information":[{"code":"92538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Basic vestibular evaluation","code_information":[{"code":"92540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Oscillating tracking test","code_information":[{"code":"92545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Tympanometry & reflex thresh","code_information":[{"code":"92550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Loudness balance test","code_information":[{"code":"92562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Visual audiometry (vra)","code_information":[{"code":"92579","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Evoked auditory test limited","code_information":[{"code":"92587","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Aep hearing status deter i&r","code_information":[{"code":"92651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Aep thrshld est mlt freq i&r","code_information":[{"code":"92652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Aep neurodiagnostic i&r","code_information":[{"code":"92653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Heart/lung resuscitation cpr","code_information":[{"code":"92950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Cardiovascular stress test","code_information":[{"code":"93017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Upr/lxtr art stdy 3+ lvls","code_information":[{"code":"93923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Lwr xtr vasc stdy bilat","code_information":[{"code":"93924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Breathing capacity test","code_information":[{"code":"94010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Spirmtry w/brnchdil inf-2 yr","code_information":[{"code":"94012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Patient recorded spirometry","code_information":[{"code":"94015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory flow volume loop","code_information":[{"code":"94375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Pulm function test by gas","code_information":[{"code":"94727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg cont rec w/vid eeg tech","code_information":[{"code":"95700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid 2-12 hr unmntr","code_information":[{"code":"95705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg wo vid 2-12hr intmt mntr","code_information":[{"code":"95706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid 2-12hr cont mntr","code_information":[{"code":"95707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr unmonitored","code_information":[{"code":"95711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Slp stdy unattended","code_information":[{"code":"95800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Sleep study unatt&resp efft","code_information":[{"code":"95806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg 41-60 minutes","code_information":[{"code":"95812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg over 1 hour","code_information":[{"code":"95813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg awake and drowsy","code_information":[{"code":"95816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg awake and asleep","code_information":[{"code":"95819","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Eeg coma or sleep only","code_information":[{"code":"95822","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Cholinesterase challenge","code_information":[{"code":"95857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test cran nerv unilat","code_information":[{"code":"95867","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test cran nerve bilat","code_information":[{"code":"95868","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test thor paraspinal","code_information":[{"code":"95869","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test one fiber","code_information":[{"code":"95872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Nvr cndj tst 1-2 studies","code_information":[{"code":"95907","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj tst 3-4 studies","code_information":[{"code":"95908","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj tst 5-6 studies","code_information":[{"code":"95909","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Ans parasymp & symp w/tilt","code_information":[{"code":"95924","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95925","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95926","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95927","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Visual evoked potential test","code_information":[{"code":"95930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Dynamic surface emg","code_information":[{"code":"96002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Neurobehavioral status exam","code_information":[{"code":"96116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Psycl tst eval phys/qhp 1st","code_information":[{"code":"96130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS 10-15dos","code_information":[{"code":"G0303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 2 porta","code_information":[{"code":"G0398","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 3 porta","code_information":[{"code":"G0399","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Home sleep test/type 4 porta","code_information":[{"code":"G0400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":214.21,"maximum":449.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":241.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":449.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.76,"additional_payer_notes":"APC"}]}]},{"description":"Myocardial imaging mcg","code_information":[{"code":"0541T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Gi myoelectrical actv study","code_information":[{"code":"0779T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Hi-res gastric ep mapping","code_information":[{"code":"0868T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Esophagus motility study","code_information":[{"code":"91010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Gastric motility studies","code_information":[{"code":"91020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Duodenal motility study","code_information":[{"code":"91022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Acid perfusion of esophagus","code_information":[{"code":"91030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Gastroesophageal reflux test","code_information":[{"code":"91034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Esoph imped funct test > 1hr","code_information":[{"code":"91038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Esoph balloon distension tst","code_information":[{"code":"91040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Anrct mano rct snsatn&balo","code_information":[{"code":"91125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam with photos","code_information":[{"code":"92230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Stenger test speech","code_information":[{"code":"92577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Evoked auditory tst complete","code_information":[{"code":"92588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Remote 30 day ecg tech supp","code_information":[{"code":"93229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Tilt table evaluation","code_information":[{"code":"93660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Meas lung vol thru 2 yrs","code_information":[{"code":"94013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of wheezing","code_information":[{"code":"94070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Pulm stress test/complex","code_information":[{"code":"94621","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis o2/co2","code_information":[{"code":"94681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Pulm funct tst plethysmograp","code_information":[{"code":"94726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Breath recording infant","code_information":[{"code":"94772","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Bronchial allergy tests","code_information":[{"code":"95070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Ingest challenge ini 120 min","code_information":[{"code":"95076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Eeg wo vid ea 12-26hr unmntr","code_information":[{"code":"95708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid ea 12-26hr intmt","code_information":[{"code":"95709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Eeg w/o vid ea 12-26hr cont","code_information":[{"code":"95710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr intmt mntr","code_information":[{"code":"95712","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Veeg 2-12 hr cont mntr","code_information":[{"code":"95713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26 hr unmntr","code_information":[{"code":"95714","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26hr intmt mntr","code_information":[{"code":"95715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Sleep study attended","code_information":[{"code":"95807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Eeg cerebral death only","code_information":[{"code":"95824","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 7-8 studies","code_information":[{"code":"95910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 9-10 studies","code_information":[{"code":"95911","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 11-12 studies","code_information":[{"code":"95912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Nrv cndj test 13/> studies","code_information":[{"code":"95913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked lwr limbs","code_information":[{"code":"95929","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"EEG monitoring/giving drugs","code_information":[{"code":"95954","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Motion analysis video/3d","code_information":[{"code":"96000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Nrpsyc tst eval phys/qhp 1st","code_information":[{"code":"96132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS complete","code_information":[{"code":"G0302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Pre-op service LVRS 1-9 dos","code_information":[{"code":"G0304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Post op service LVRS min 6","code_information":[{"code":"G0305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"Blinded conv. Tx MDD clin tr","code_information":[{"code":"G2000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":370.20,"maximum":777.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":416.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":777.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":409.16,"additional_payer_notes":"APC"}]}]},{"description":"N-invas augmnt arrhyt alys","code_information":[{"code":"0897T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"N-invas prst8 cancer est map","code_information":[{"code":"0898T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Drain bladder by trocar/cath","code_information":[{"code":"51101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Electroconvulsive therapy","code_information":[{"code":"90870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"G-esoph reflx tst w/electrod","code_information":[{"code":"91035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Percut allergy skin tests","code_information":[{"code":"95004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Allergy patch tests","code_information":[{"code":"95044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Veeg ea 12-26hr cont mntr","code_information":[{"code":"95716","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Polysom <6 yrs 4/> paramtrs","code_information":[{"code":"95782","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Polysom <6 yrs cpap/bilvl","code_information":[{"code":"95783","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Multiple sleep latency test","code_information":[{"code":"95805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Polysom any age 1-3> param","code_information":[{"code":"95808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Polysom 6/> yrs 4/> param","code_information":[{"code":"95810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Polysom 6/>yrs cpap 4/> parm","code_information":[{"code":"95811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked uppr limbs","code_information":[{"code":"95928","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Somatosensory testing","code_information":[{"code":"95938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"C motor evoked upr&lwr limbs","code_information":[{"code":"95939","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"EEG monitoring/function test","code_information":[{"code":"95958","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Electrode stimulation brain","code_information":[{"code":"95961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Meg spontaneous","code_information":[{"code":"95965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Meg evoked single","code_information":[{"code":"95966","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Motion test w/ft press meas","code_information":[{"code":"96001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Pre-plan 3d model w/ccta","code_information":[{"code":"C9793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Replacment pt electronic sys","code_information":[{"code":"G0555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":851.93,"maximum":1788.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":851.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.6,"additional_payer_notes":"APC"}]}]},{"description":"Cool Quant Sensory Test","code_information":[{"code":"0108T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Ins bone device for rsa","code_information":[{"code":"0347T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Mac pgmt opt dns meas hfp","code_information":[{"code":"0506T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Near ifr 2img mibmn glnd i&r","code_information":[{"code":"0507T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Evac meibomian glnd heat bi","code_information":[{"code":"0563T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Car acous wavfrm rec cad rsk","code_information":[{"code":"0716T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Augmnt ai-based fcl phnt a/r","code_information":[{"code":"0731T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Rem auton alg nsln cal setup","code_information":[{"code":"0740T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Pt spec alg rx-onc tx option","code_information":[{"code":"0794T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Ecg alg 12 ld rdcd trcg only","code_information":[{"code":"0904T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly nstm sys vgs nrv wo","code_information":[{"code":"0911T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Elec aly npgs esoph sbsq w/o","code_information":[{"code":"1017T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Raman spectroscopy 1+skn les","code_information":[{"code":"1020T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Trim nail(s) any number","code_information":[{"code":"11719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Debride nail 1-5","code_information":[{"code":"11720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Debride nail 6 or more","code_information":[{"code":"11721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Cryotherapy of skin","code_information":[{"code":"17340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Application of finger splint","code_information":[{"code":"29131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of elbow or wrist","code_information":[{"code":"29260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of hand or finger","code_information":[{"code":"29280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of toes","code_information":[{"code":"29550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Urinary reflex study","code_information":[{"code":"51792","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Us urine capacity measure","code_information":[{"code":"51798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Treat vagina infection","code_information":[{"code":"57150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Remove impacted ear wax uni","code_information":[{"code":"69210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Coombs test direct","code_information":[{"code":"86880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing patient serum","code_information":[{"code":"86904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretx incubatj w/chemicl","code_information":[{"code":"86970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Rbc pretreatment serum","code_information":[{"code":"86978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Path consult introp","code_information":[{"code":"88329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Corneal Topography","code_information":[{"code":"92025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Special eye evaluation","code_information":[{"code":"92060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Orthop traing supvj phys/qhp","code_information":[{"code":"92066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92082","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Cmptr ophth dx img ant segmt","code_information":[{"code":"92132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Cmptr ophth img optic nerve","code_information":[{"code":"92133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Cptr ophth dx img post segmt","code_information":[{"code":"92134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Corneal hysteresis deter","code_information":[{"code":"92145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Opscpy extnd rta draw uni/bi","code_information":[{"code":"92201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Opscpy extnd on/mac draw","code_information":[{"code":"92202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Remote dx retinal imaging","code_information":[{"code":"92227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Img rta detc/mntr ds poc aly","code_information":[{"code":"92229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Eye muscle evaluation","code_information":[{"code":"92265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Color vision examination","code_information":[{"code":"92283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Replacement of contact lens","code_information":[{"code":"92326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Fit aphakia spectcl monofocl","code_information":[{"code":"92352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Fit aphakia spectcl multifoc","code_information":[{"code":"92353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Aphakia prosth service temp","code_information":[{"code":"92358","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Repair & adjust spectacles","code_information":[{"code":"92371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Speech threshold audiometry","code_information":[{"code":"92555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Speech audiometry complete","code_information":[{"code":"92556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Stenger test pure tone","code_information":[{"code":"92565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Select picture audiometry","code_information":[{"code":"92583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Electrocardiogram tracing","code_information":[{"code":"93005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Rhythm ecg tracing","code_information":[{"code":"93041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"ECG/signal-averaged","code_information":[{"code":"93278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Peripheral Vascular Rehab","code_information":[{"code":"93668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Lung function test (MBC/MVV)","code_information":[{"code":"94200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Exercise tst brncspsm wo ecg","code_information":[{"code":"94619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Phy/qhp op pulm rhb w/o mntr","code_information":[{"code":"94625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Phy/qhp op pulm rhb w/mntr","code_information":[{"code":"94626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled air analysis","code_information":[{"code":"94690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Icut allergy test drug/bug","code_information":[{"code":"95024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Photo patch test","code_information":[{"code":"95052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Cont gluc mntr pt prov eqp","code_information":[{"code":"95249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Slp stdy unatnd w/anal","code_information":[{"code":"95801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Actigraphy testing","code_information":[{"code":"95803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Blink reflex test","code_information":[{"code":"95933","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Io anal gast n-stim subsq","code_information":[{"code":"95981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Irrig drug delivery device","code_information":[{"code":"96523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy with UV-B","code_information":[{"code":"96910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Photochemotherapy with UV-A","code_information":[{"code":"96912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Trim nail(s)","code_information":[{"code":"G0127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Pathogen test for platelets","code_information":[{"code":"P9100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.52,"maximum":122.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.68,"additional_payer_notes":"APC"}]}]},{"description":"Nos Quant Sensory Test","code_information":[{"code":"0110T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Ocular blood flow measure","code_information":[{"code":"0198T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Clear eyelid gland w/heat","code_information":[{"code":"0207T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Eye mvmt alys w/o calbrj i&r","code_information":[{"code":"0615T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg ecg rsk asmt cncrt","code_information":[{"code":"0764T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg ecg rsk asmt prev","code_information":[{"code":"0765T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Instlj fecal microbiota ssp","code_information":[{"code":"0780T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"N-invas assmt bld oxygnation","code_information":[{"code":"0893T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Qtc ntrvl augmnt alg aly ecg","code_information":[{"code":"0902T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Asstv alg alys acous&ecg rec","code_information":[{"code":"0962T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Elec alys s-scl eeg wo prgrm","code_information":[{"code":"1004T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Cptr oph alys monoc eye mvmt","code_information":[{"code":"1010T","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Drain blood from under nail","code_information":[{"code":"11740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Insert drug implant device","code_information":[{"code":"11981","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Apply forearm splint","code_information":[{"code":"29126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Application of finger splint","code_information":[{"code":"29130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of shoulder","code_information":[{"code":"29240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of hip","code_information":[{"code":"29520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Strapping of knee","code_information":[{"code":"29530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove nasal foreign body","code_information":[{"code":"30300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Control of nosebleed","code_information":[{"code":"30905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Vein access cutdown < 1 yr","code_information":[{"code":"36420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Draw blood off venous device","code_information":[{"code":"36591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Collect blood from picc","code_information":[{"code":"36592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Withdrawal of arterial blood","code_information":[{"code":"36600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Drainage of gum lesion","code_information":[{"code":"41800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Diagnostic anoscopy spx","code_information":[{"code":"46600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Insert bladder catheter","code_information":[{"code":"51701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Insert temp bladder cath","code_information":[{"code":"51702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Urine flow measurement","code_information":[{"code":"51736","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Dilate urethra stricture","code_information":[{"code":"53601","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Dilation of urethra","code_information":[{"code":"53661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Remove foreign body from eye","code_information":[{"code":"65222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Revise eyelashes","code_information":[{"code":"67820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Clear outer ear canal","code_information":[{"code":"69200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Blood typing serologic abo","code_information":[{"code":"86900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Special stains group 2","code_information":[{"code":"88313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Electrogastrography W/Test","code_information":[{"code":"91133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Special eye evaluation","code_information":[{"code":"92020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Visual field examination(s)","code_information":[{"code":"92083","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Ophthalmic biometry","code_information":[{"code":"92136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Eye exam with photos","code_information":[{"code":"92250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Electro-oculography","code_information":[{"code":"92270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Internal eye photography","code_information":[{"code":"92286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Internal eye photography","code_information":[{"code":"92287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Contact lens fitting","code_information":[{"code":"92313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Rx cntact lens aphakia 1 eye","code_information":[{"code":"92315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Rx cntact lens aphakia 2 eye","code_information":[{"code":"92316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Modification of contact lens","code_information":[{"code":"92325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Laryngeal function studies","code_information":[{"code":"92520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Spontaneous nystagmus test","code_information":[{"code":"92541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Positional nystagmus test","code_information":[{"code":"92542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Posturography","code_information":[{"code":"92548","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Cdp-sot 6 cond w/i&r mct&adt","code_information":[{"code":"92549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Pure tone audiometry air","code_information":[{"code":"92552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Ecg monit/reprt up to 48 hrs","code_information":[{"code":"93225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>48hr<7d scan a/r","code_information":[{"code":"93243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Ext ecg>7d<15d scan a/r","code_information":[{"code":"93247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Bioimpedance cv analysis","code_information":[{"code":"93701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Ambulatory BP recording","code_information":[{"code":"93786","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Ambulatory BP analysis","code_information":[{"code":"93788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Upr/l xtremity art 2 levels","code_information":[{"code":"93922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Hast w/report","code_information":[{"code":"94452","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Hast w/oxygen titrate","code_information":[{"code":"94453","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Exercise tst brncspsm","code_information":[{"code":"94617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Pulmonary stress testing","code_information":[{"code":"94618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Cbt 1st hour","code_information":[{"code":"94644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Chest wall manipulation","code_information":[{"code":"94667","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Chest wall manipulation","code_information":[{"code":"94668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Photosensitivity tests","code_information":[{"code":"95056","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Eye allergy tests","code_information":[{"code":"95060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test one limb","code_information":[{"code":"95860","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test 2 limbs","code_information":[{"code":"95861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test larynx","code_information":[{"code":"95865","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Muscle test nonparaspinal","code_information":[{"code":"95870","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Quan puplmtry phy/qhp uni/bi","code_information":[{"code":"95919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv adrenrg inervj","code_information":[{"code":"95922","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Autonomic nrv syst funj test","code_information":[{"code":"95923","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Analyze neurostim no prog","code_information":[{"code":"95970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Psycl/nrpsyc tst phy/qhp 1st","code_information":[{"code":"96136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Phlebotomy","code_information":[{"code":"99195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Extrnl counterpulse, per tx","code_information":[{"code":"G0166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":131.99,"maximum":277.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":148.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":277.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.89,"additional_payer_notes":"APC"}]}]},{"description":"Temporary external pacing","code_information":[{"code":"92953","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.70,"maximum":1376.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":738.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":710.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":690.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":767.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1376.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":731.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":724.72,"additional_payer_notes":"APC"}]}]},{"description":"Cardioversion electric ext","code_information":[{"code":"92960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.70,"maximum":1376.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":738.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":710.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":690.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":767.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1376.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":731.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":724.72,"additional_payer_notes":"APC"}]}]},{"description":"Cardioversion electric int","code_information":[{"code":"92961","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.70,"maximum":1376.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":738.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":710.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":690.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":767.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1376.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":731.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":724.72,"additional_payer_notes":"APC"}]}]},{"description":"Nb resuscitation","code_information":[{"code":"99465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.70,"maximum":1376.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":738.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":710.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":690.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":717.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":767.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1376.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":731.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":724.72,"additional_payer_notes":"APC"}]}]},{"description":"Clearance of airways","code_information":[{"code":"31720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":456.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":456.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.11,"additional_payer_notes":"APC"}]}]},{"description":"Surfactant Admin Thru Tube","code_information":[{"code":"94610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":456.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":456.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.11,"additional_payer_notes":"APC"}]}]},{"description":"Airway inhalation treatment","code_information":[{"code":"94640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":456.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":456.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.11,"additional_payer_notes":"APC"}]}]},{"description":"Aerosol inhalation treatment","code_information":[{"code":"94642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":456.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":456.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.11,"additional_payer_notes":"APC"}]}]},{"description":"Pos airway pressure cpap","code_information":[{"code":"94660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":456.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":456.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.11,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate pt use of inhaler","code_information":[{"code":"94664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":456.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":456.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.11,"additional_payer_notes":"APC"}]}]},{"description":"Mechanical chest wall oscill","code_information":[{"code":"94669","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":217.24,"maximum":456.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":456.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":240.11,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna hea 35 ag 11 bld grp","code_information":[{"code":"0001U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.0,"maximum":1435.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":770.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":684.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":800.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1435.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":763.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.0,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/ash","code_information":[{"code":"0002M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.23,"maximum":1003.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":478.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":523.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":559.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1003.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":533.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":528.57,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct 3 ur metab alg plp","code_information":[{"code":"0002U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.75,"maximum":49.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.25,"additional_payer_notes":"APC"}]}]},{"description":"Liver dis 10 assays w/nash","code_information":[{"code":"0003M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.23,"maximum":1003.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":478.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":523.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":559.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1003.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":533.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":528.57,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovar 5 prtn ser alg scor","code_information":[{"code":"0003U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.5,"maximum":1894.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1016.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":902.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":988.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1056.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1894.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1007.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":997.5,"additional_payer_notes":"APC"}]}]},{"description":"Scoliosis dna alys","code_information":[{"code":"0004M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.05,"maximum":157.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":157.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.95,"additional_payer_notes":"APC"}]}]},{"description":"Onco prst8 3 gene ur alg","code_information":[{"code":"0005U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc hep gene risk classifier","code_information":[{"code":"0006M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.5,"maximum":299.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":299.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc gastro 51 gene nomogram","code_information":[{"code":"0007M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.25,"maximum":747.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":401.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":747.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":393.75,"additional_payer_notes":"APC"}]}]},{"description":"Rx test prsmv ur w/def conf","code_information":[{"code":"0007U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.71,"maximum":228.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":228.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.15,"additional_payer_notes":"APC"}]}]},{"description":"Hpylori detcj abx rstnc dna","code_information":[{"code":"0008U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.01,"maximum":1192.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":568.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":664.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1192.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":627.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca erbb2 amp/nonamp","code_information":[{"code":"0009U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":101.65,"maximum":213.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":107.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":111.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":213.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112.35,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds strn typ whl gen seq","code_information":[{"code":"0010U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":405.90,"maximum":852.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":457.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":440.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":405.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":427.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":444.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":475.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":852.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":452.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":448.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca mrna 12 gen alg","code_information":[{"code":"0011M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr lc-ms/ms oral fluid","code_information":[{"code":"0011U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.71,"maximum":228.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":228.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.15,"additional_payer_notes":"APC"}]}]},{"description":"Adrnl cortcl tum bchm asy 25","code_information":[{"code":"0015M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1240.10,"maximum":2603.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1396.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1344.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1240.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1305.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1357.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1451.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2603.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1383.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1370.64,"additional_payer_notes":"APC"}]}]},{"description":"Onc bladder mrna 209 gen alg","code_information":[{"code":"0016M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3315.15,"maximum":6959.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3733.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3594.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3315.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3489.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3629.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3880.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6959.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3699.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3664.11,"additional_payer_notes":"APC"}]}]},{"description":"Onc hmtlmf neo rna bcr/abl1","code_information":[{"code":"0016U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.76,"maximum":326.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":175.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":163.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":170.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":326.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172.16,"additional_payer_notes":"APC"}]}]},{"description":"Onc dlbcl mrna 20 genes alg","code_information":[{"code":"0017M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2384.70,"maximum":5006.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2685.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2384.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2610.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2791.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5006.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2660.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2635.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc hmtlmf neo jak2 mut dna","code_information":[{"code":"0017U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.08,"maximum":182.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":182.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.24,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj rnl meas cd154+cll","code_information":[{"code":"0018M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.69,"maximum":1277.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":685.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":659.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":640.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1277.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":679.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":672.77,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr 10 microrna seq alg","code_information":[{"code":"0018U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2851.99,"maximum":5987.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3212.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3092.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2851.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3002.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3122.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3338.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5987.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3182.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3152.19,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds plasma alys prtn bmrk","code_information":[{"code":"0019M","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.78,"maximum":1420.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":733.77,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":740.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":792.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1420.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":755.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":748.02,"additional_payer_notes":"APC"}]}]},{"description":"Onc rna tiss predict alg","code_information":[{"code":"0019U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3491.25,"maximum":7329.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3932.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3785.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3491.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3822.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4086.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7329.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3895.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3858.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 detcj 8 autoantb","code_information":[{"code":"0021U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna&rna 23 gene","code_information":[{"code":"0022U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1852.5,"maximum":3888.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1852.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2168.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3888.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2047.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc aml dna detcj/nondetcj","code_information":[{"code":"0023U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":236.08,"maximum":495.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":265.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":255.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":236.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":248.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":495.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":263.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":260.94,"additional_payer_notes":"APC"}]}]},{"description":"Glyca nuc mr spectrsc quan","code_information":[{"code":"0024U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.48,"maximum":68.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":68.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.9,"additional_payer_notes":"APC"}]}]},{"description":"Tenofovir liq chrom ur quan","code_information":[{"code":"0025U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.71,"maximum":228.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":228.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr dna&mrna 112 genes","code_information":[{"code":"0026U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3420.0,"maximum":7179.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4003.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7179.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3780.0,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene trgt seq alys","code_information":[{"code":"0027U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.81,"maximum":243.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.01,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs trgt seq alys","code_information":[{"code":"0029U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":705.16,"maximum":1480.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":794.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":764.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":705.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":825.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1480.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":786.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.38,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab warf trgt seq alys","code_information":[{"code":"0030U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.42,"maximum":267.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140.84,"additional_payer_notes":"APC"}]}]},{"description":"Cyp1a2 gene","code_information":[{"code":"0031U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Comt gene","code_information":[{"code":"0032U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Tpmt nudt15 genes","code_information":[{"code":"0034U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":442.86,"maximum":929.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":498.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":484.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":929.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":494.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":489.48,"additional_payer_notes":"APC"}]}]},{"description":"Neuro csf prion prtn qual","code_information":[{"code":"0035U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":513.94,"maximum":1078.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":513.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":562.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1078.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":573.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":568.04,"additional_payer_notes":"APC"}]}]},{"description":"Xome tum & nml spec seq alys","code_information":[{"code":"0036U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4541.0,"maximum":9532.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5114.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4923.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4541.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4971.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5315.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9532.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5066.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5019.0,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna 324 genes","code_information":[{"code":"0037U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3325.0,"maximum":6980.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3325.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3892.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6980.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin d srm microsamp quan","code_information":[{"code":"0038U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.12,"maximum":59.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.08,"additional_payer_notes":"APC"}]}]},{"description":"Dna antb 2strand hi avidity","code_information":[{"code":"0039U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.05,"maximum":27.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene major bp quan","code_information":[{"code":"0040U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":389.40,"maximum":817.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":438.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":422.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":389.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":409.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":426.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":455.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":817.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.4,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi antb 5 prtn igm","code_information":[{"code":"0041U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.35,"maximum":34.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.07,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi antb 12 prtn igg","code_information":[{"code":"0042U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.35,"maximum":34.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.07,"additional_payer_notes":"APC"}]}]},{"description":"Tbrf b grp antb 4 prtn igm","code_information":[{"code":"0043U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.12,"maximum":29.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"}]}]},{"description":"Tbrf b grp antb 4 prtn igg","code_information":[{"code":"0044U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.12,"maximum":29.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst dux carc is 12 gene","code_information":[{"code":"0045U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene itd variants quan","code_information":[{"code":"0046U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.06,"maximum":812.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":435.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":387.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":423.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":453.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":812.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":431.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":427.8,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna 17 gene alg","code_information":[{"code":"0047U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld org neo dna 468 gene","code_information":[{"code":"0048U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Npm1 gene analysis quan","code_information":[{"code":"0049U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.06,"maximum":812.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":435.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":387.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":423.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":453.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":812.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":431.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":427.8,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq dna 194 genes","code_information":[{"code":"0050U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2770.77,"maximum":5816.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3120.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3004.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2770.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2916.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3243.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5816.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3091.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3062.43,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr lc-ms/ms ur 31 pnl","code_information":[{"code":"0051U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Lpoprtn bld w/5 maj classes","code_information":[{"code":"0052U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.17,"maximum":67.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.55,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 14+ drugs & sbsts","code_information":[{"code":"0054U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.80,"maximum":396.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":396.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.68,"additional_payer_notes":"APC"}]}]},{"description":"Card hrt trnspl 96 dna seq","code_information":[{"code":"0055U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3078.0,"maximum":6461.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3466.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3078.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3602.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6461.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3434.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc merkel cll carc srm quan","code_information":[{"code":"0058U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.81,"maximum":644.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":306.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":359.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":644.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.11,"additional_payer_notes":"APC"}]}]},{"description":"Onc merkel cll carc srm +/-","code_information":[{"code":"0059U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.81,"maximum":644.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":306.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":359.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":644.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.11,"additional_payer_notes":"APC"}]}]},{"description":"Twn zyg gen seq alys chrms2","code_information":[{"code":"0060U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Tc meas 5 bmrk sfdi m-s alys","code_information":[{"code":"0061U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.84,"maximum":50.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.36,"additional_payer_notes":"APC"}]}]},{"description":"Ai sle igg&igm alys 80 bmrk","code_information":[{"code":"0062U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.68,"maximum":759.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":407.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":392.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":361.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":380.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":423.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":759.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":399.76,"additional_payer_notes":"APC"}]}]},{"description":"Neuro autism 32 amines alg","code_information":[{"code":"0063U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.5,"maximum":1495.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":834.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1495.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.5,"additional_payer_notes":"APC"}]}]},{"description":"Antb tp total&rpr ia qual","code_information":[{"code":"0064U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.76,"maximum":62.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"}]}]},{"description":"Syfls tst nontreponemal antb","code_information":[{"code":"0065U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.19,"maximum":36.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.99,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst imhchem prfl 4 bmrk","code_information":[{"code":"0067U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1802.15,"maximum":3783.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2029.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1953.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1802.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1897.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2109.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3783.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2010.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1991.85,"additional_payer_notes":"APC"}]}]},{"description":"Candida species pnl amp prb","code_information":[{"code":"0068U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct microrna mir-31-3p","code_information":[{"code":"0069U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.0,"maximum":757.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":406.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":361.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":380.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":422.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":757.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":399.0,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen com&slct rar vrnt","code_information":[{"code":"0070U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":642.55,"maximum":1348.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":723.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":696.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":642.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":703.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":752.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1348.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":716.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":710.19,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 full gene sequence","code_information":[{"code":"0071U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.0,"maximum":1196.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":667.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1196.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.0,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen cyp2d6-2d7 hybrid","code_information":[{"code":"0072U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.36,"maximum":899.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":428.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":899.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":473.46,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gen cyp2d7-2d6 hybrid","code_information":[{"code":"0073U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.36,"maximum":899.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":428.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":899.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":473.46,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 nonduplicated gene","code_information":[{"code":"0074U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.36,"maximum":899.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":428.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":899.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":473.46,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 5' gene dup/mlt","code_information":[{"code":"0075U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.36,"maximum":899.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":428.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":899.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":473.46,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 3' gene dup/mlt","code_information":[{"code":"0076U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.36,"maximum":899.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":428.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":899.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":473.46,"additional_payer_notes":"APC"}]}]},{"description":"Ig paraprotein qual bld/ur","code_information":[{"code":"0077U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.26,"maximum":86.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":86.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.6,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng 5 clin rsk factr alg","code_information":[{"code":"0080U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3344.0,"maximum":7019.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3766.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3625.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3344.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3520.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3660.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3914.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7019.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3731.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3696.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx test def 90+ rx/sbsts ur","code_information":[{"code":"0082U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Onc rspse chemo cntrst tomog","code_information":[{"code":"0083U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":158.98,"maximum":333.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":179.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":186.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":333.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":175.72,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gnotyp 10 bld groups","code_information":[{"code":"0084U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.0,"maximum":1435.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":770.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":684.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":800.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1435.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":763.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.0,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng org id 6+","code_information":[{"code":"0086U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.0,"maximum":398.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":214.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":398.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.0,"additional_payer_notes":"APC"}]}]},{"description":"Crd hrt trnspl mrna 1283 gen","code_information":[{"code":"0087U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3001.45,"maximum":6300.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3380.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3001.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3285.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3513.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6300.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3348.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3317.39,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj kdn algrft rej 1494","code_information":[{"code":"0088U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3001.45,"maximum":6300.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3380.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3001.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3285.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3513.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6300.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3348.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3317.39,"additional_payer_notes":"APC"}]}]},{"description":"Onc mlnma prame & linc00518","code_information":[{"code":"0089U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 23 gene","code_information":[{"code":"0090U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1852.5,"maximum":3888.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1852.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2168.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3888.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2047.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng 3 prtn bmrk plsm alg","code_information":[{"code":"0092U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2363.6,"maximum":4961.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2662.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2562.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2363.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2488.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2587.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2766.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4961.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2637.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2612.4,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 65 com drugs urine","code_information":[{"code":"0093U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.03,"maximum":123.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":123.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.25,"additional_payer_notes":"APC"}]}]},{"description":"Genome rapid sequence alys","code_information":[{"code":"0094U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7203.09,"maximum":15121.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8112.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7203.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7885.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8431.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15121.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8037.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7961.31,"additional_payer_notes":"APC"}]}]},{"description":"Inflm ee elisa alys alg","code_information":[{"code":"0095U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":733.38,"maximum":1539.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":826.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":733.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":802.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":858.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1539.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":810.58,"additional_payer_notes":"APC"}]}]},{"description":"Hpv hi risk types male urine","code_information":[{"code":"0096U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca do 15 genes","code_information":[{"code":"0101U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1656.75,"maximum":3477.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1866.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1796.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1656.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1743.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1813.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1939.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3477.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1848.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1831.15,"additional_payer_notes":"APC"}]}]},{"description":"Hered brst ca rltd do 17 gen","code_information":[{"code":"0102U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.75,"maximum":2600.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1238.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1449.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2600.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1369.15,"additional_payer_notes":"APC"}]}]},{"description":"Hered ova ca pnl 24 genes","code_information":[{"code":"0103U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1656.75,"maximum":3477.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1866.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1796.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1656.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1743.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1813.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1939.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3477.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1848.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1831.15,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd mult eclia tum nec","code_information":[{"code":"0105U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.5,"maximum":1894.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1016.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":902.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":988.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1056.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1894.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1007.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":997.5,"additional_payer_notes":"APC"}]}]},{"description":"Gstr emptg 7 timed brth spec","code_information":[{"code":"0106U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":830.77,"maximum":1744.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":935.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":900.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":830.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":874.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":909.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":972.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1744.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":926.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":918.21,"additional_payer_notes":"APC"}]}]},{"description":"C diff tox ag detcj ia stool","code_information":[{"code":"0107U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.2,"maximum":31.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"}]}]},{"description":"Gi barrett esoph 9 prtn bmrk","code_information":[{"code":"0108U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4702.5,"maximum":9871.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5296.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5098.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4702.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5148.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5504.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9871.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5247.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5197.5,"additional_payer_notes":"APC"}]}]},{"description":"Id aspergillus dna 4 species","code_information":[{"code":"0109U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr 1+oral onc rx&sbsts","code_information":[{"code":"0110U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.75,"maximum":54.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"}]}]},{"description":"Onc colon ca kras&nras alys","code_information":[{"code":"0111U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":648.18,"maximum":1360.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":730.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":648.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":682.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":709.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":758.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1360.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":723.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":716.4,"additional_payer_notes":"APC"}]}]},{"description":"Iadi 16s&18s rrna genes","code_information":[{"code":"0112U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":338.32,"maximum":710.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":381.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":366.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":338.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":370.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":710.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":377.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":373.94,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 pca3&tmprss2-erg","code_information":[{"code":"0113U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Gi barretts esoph vim&ccna1","code_information":[{"code":"0114U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.11,"maximum":3864.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2073.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1841.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2015.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2155.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3864.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2054.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2034.91,"additional_payer_notes":"APC"}]}]},{"description":"Respir iadna 18 viral&2 bact","code_information":[{"code":"0115U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.58,"maximum":549.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":275.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":306.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":549.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":289.12,"additional_payer_notes":"APC"}]}]},{"description":"Rx mntr nzm ia 35+oral flu","code_information":[{"code":"0116U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Pain mgmt 11 endogenous anal","code_information":[{"code":"0117U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.62,"maximum":1676.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":798.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":934.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1676.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":882.68,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj don-drv cll-fr dna","code_information":[{"code":"0118U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2615.59,"maximum":5490.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2615.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2863.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3061.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5490.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2918.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2890.91,"additional_payer_notes":"APC"}]}]},{"description":"Crd ceramides liq chrom plsm","code_information":[{"code":"0119U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.57,"maximum":167.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":167.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc b cll lymphm mrna 58 gen","code_information":[{"code":"0120U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2384.70,"maximum":5006.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2685.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2384.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2610.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2791.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5006.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2660.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2635.72,"additional_payer_notes":"APC"}]}]},{"description":"Sc dis vcam-1 whole blood","code_information":[{"code":"0121U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":483.74,"maximum":1015.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":544.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":524.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":483.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":509.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":529.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":566.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1015.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":539.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":534.66,"additional_payer_notes":"APC"}]}]},{"description":"Sc dis p-selectin whl blood","code_information":[{"code":"0122U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":499.92,"maximum":1049.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":563.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":542.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":499.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":526.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":547.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":585.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1049.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":557.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":552.54,"additional_payer_notes":"APC"}]}]},{"description":"Mchnl fragility rbc prflg","code_information":[{"code":"0123U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.75,"maximum":713.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":368.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":357.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":713.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":379.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":375.51,"additional_payer_notes":"APC"}]}]},{"description":"Hered brst ca rltd do panel","code_information":[{"code":"0129U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.75,"maximum":2600.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1238.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1449.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2600.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1369.15,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca do mrna pnl","code_information":[{"code":"0130U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.66,"maximum":1166.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":555.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":650.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1166.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.14,"additional_payer_notes":"APC"}]}]},{"description":"Hered prst8 ca rltd do 11","code_information":[{"code":"0133U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":655.78,"maximum":1376.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":738.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":711.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":655.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":690.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":717.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":767.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1376.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":731.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":724.8,"additional_payer_notes":"APC"}]}]},{"description":"Hered pan ca mrna pnl 18 gen","code_information":[{"code":"0134U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":710.97,"maximum":1492.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":800.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":770.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":710.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":778.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":832.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1492.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":793.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":785.81,"additional_payer_notes":"APC"}]}]},{"description":"Atm mrna seq alys","code_information":[{"code":"0136U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":387.06,"maximum":812.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":435.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":419.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":387.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":407.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":423.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":453.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":812.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":431.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":427.8,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 mrna seq alys","code_information":[{"code":"0137U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 brca2 mrna seq alys","code_information":[{"code":"0138U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.91,"maximum":933.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":501.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":482.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":444.91,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":487.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":520.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":933.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":496.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":491.75,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds fungi dna 15 trgt","code_information":[{"code":"0140U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.91,"maximum":312.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.91,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":163.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":312.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.59,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng gram pos","code_information":[{"code":"0141U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.91,"maximum":312.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.91,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":163.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":312.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.59,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bact&fng gram neg","code_information":[{"code":"0142U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.91,"maximum":312.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.91,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":163.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":312.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.59,"additional_payer_notes":"APC"}]}]},{"description":"Nfct bct fng prst dna >1000","code_information":[{"code":"0152U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2019.89,"maximum":4240.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2275.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2019.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2211.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2364.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4240.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2253.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2232.51,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 101 genes","code_information":[{"code":"0153U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3001.45,"maximum":6300.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3380.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3001.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3285.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3513.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6300.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3348.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3317.39,"additional_payer_notes":"APC"}]}]},{"description":"Fgfr3 gene analysis","code_information":[{"code":"0154U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":458.03,"maximum":961.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":515.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":496.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":458.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":482.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":536.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":961.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":511.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":506.25,"additional_payer_notes":"APC"}]}]},{"description":"Pik3ca gene analysis","code_information":[{"code":"0155U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Copy number sequence alys","code_information":[{"code":"0156U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1653.0,"maximum":3470.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1861.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1792.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1653.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1740.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1809.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1934.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3470.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1844.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1827.0,"additional_payer_notes":"APC"}]}]},{"description":"Apc mrna seq alys","code_information":[{"code":"0157U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 mrna seq alys","code_information":[{"code":"0158U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 mrna seq alys","code_information":[{"code":"0159U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 mrna seq alys","code_information":[{"code":"0160U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 mrna seq alys","code_information":[{"code":"0161U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Hered colon ca trgt mrna pnl","code_information":[{"code":"0162U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":462.21,"maximum":970.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":520.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":462.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":486.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":506.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":541.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":970.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":510.87,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibs ia anti-cdtb&vinculin","code_information":[{"code":"0164U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":106.42,"maximum":223.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":119.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":124.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":223.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117.62,"additional_payer_notes":"APC"}]}]},{"description":"Peanut allg spec asmt 64 epi","code_information":[{"code":"0165U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":440.57,"maximum":924.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":496.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":477.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":440.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":482.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":924.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":491.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":486.95,"additional_payer_notes":"APC"}]}]},{"description":"Liver ds 10 biochem asy srm","code_information":[{"code":"0166U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.23,"maximum":1003.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":538.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":478.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":503.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":523.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":559.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1003.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":533.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":528.57,"additional_payer_notes":"APC"}]}]},{"description":"Nudt15&tpmt gene com vrnt","code_information":[{"code":"0169U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":442.86,"maximum":929.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":498.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":484.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":929.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":494.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":489.48,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd rna next gen seq","code_information":[{"code":"0170U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1852.5,"maximum":3888.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1852.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2168.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3888.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2047.5,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl dna 23","code_information":[{"code":"0171U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1443.11,"maximum":3029.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1625.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1564.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1443.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1519.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1579.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1689.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3029.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1610.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1595.01,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum alys brca1 brca2","code_information":[{"code":"0172U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2878.5,"maximum":6042.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3242.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3120.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2878.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3030.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3151.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6042.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3211.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3181.5,"additional_payer_notes":"APC"}]}]},{"description":"Psyc gen alys panel 14 genes","code_information":[{"code":"0173U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":442.86,"maximum":929.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":498.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":480.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":442.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":466.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":484.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":929.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":494.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":489.48,"additional_payer_notes":"APC"}]}]},{"description":"Onc solid tumor 30 prtn trgt","code_information":[{"code":"0174U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1240.10,"maximum":2603.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1396.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1344.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1240.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1305.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1357.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1451.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2603.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1383.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1370.64,"additional_payer_notes":"APC"}]}]},{"description":"Psyc gen alys panel 15 genes","code_information":[{"code":"0175U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.29,"maximum":2664.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1485.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2664.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1402.89,"additional_payer_notes":"APC"}]}]},{"description":"Cdtb&vinculin igg antb ia","code_information":[{"code":"0176U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.98,"maximum":128.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.4,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca dna pik3ca 11","code_information":[{"code":"0177U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Peanut allg asmt epi clin rx","code_information":[{"code":"0178U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":436.87,"maximum":917.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":492.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":473.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":436.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":459.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":478.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":511.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":917.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":487.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":482.85,"additional_payer_notes":"APC"}]}]},{"description":"Onc nonsm cll lng ca alys 23","code_information":[{"code":"0179U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1846.05,"maximum":3875.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2079.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2001.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1846.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1943.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2020.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2160.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3875.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2059.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2040.37,"additional_payer_notes":"APC"}]}]},{"description":"Abo gnotyp abo 7 exons","code_information":[{"code":"0180U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Co gnotyp aqp1 exon 1","code_information":[{"code":"0181U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Crom gnotyp cd55 exons 1-10","code_information":[{"code":"0182U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":286.28,"maximum":600.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":600.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.42,"additional_payer_notes":"APC"}]}]},{"description":"Di gnotyp slc4a1 exon 19","code_information":[{"code":"0183U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Do gnotyp art4 exon 2","code_information":[{"code":"0184U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Fut1 gnotyp fut1 exon 4","code_information":[{"code":"0185U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Fut2 gnotyp fut2 exon 2","code_information":[{"code":"0186U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Fy gnotyp ackr1 exons 1-2","code_information":[{"code":"0187U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Ge gnotyp gypc exons 1-4","code_information":[{"code":"0188U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Gypa gnotyp ntrns 1 5 exon 2","code_information":[{"code":"0189U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Gypb gnotyp ntrns 1 5 seux 3","code_information":[{"code":"0190U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"In gnotyp cd44 exons 2 3 6","code_information":[{"code":"0191U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Jk gnotyp slc14a1 exon 9","code_information":[{"code":"0192U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Jr gnotyp abcg2 exons 2-26","code_information":[{"code":"0193U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Kel gnotyp kel exon 8","code_information":[{"code":"0194U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Klf1 targeted sequencing","code_information":[{"code":"0195U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.49,"maximum":748.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":748.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.01,"additional_payer_notes":"APC"}]}]},{"description":"Lu gnotyp bcam exon 3","code_information":[{"code":"0196U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Lw gnotyp icam4 exon 1","code_information":[{"code":"0197U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Rhd&rhce gntyp rhd1-10&rhce5","code_information":[{"code":"0198U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Sc gnotyp ermap exons 4 12","code_information":[{"code":"0199U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Xk gnotyp xk exons 1-3","code_information":[{"code":"0200U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Yt gnotyp ache exon 2","code_information":[{"code":"0201U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds 22 trgt sars-cov-2","code_information":[{"code":"0202U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Ai ibd mrna xprsn prfl 17","code_information":[{"code":"0203U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Oph amd alys 3 gene variants","code_information":[{"code":"0205U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.65,"maximum":93.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":93.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.35,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alzheimer cell aggregj","code_information":[{"code":"0206U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2104.63,"maximum":4418.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2370.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2281.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2104.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2215.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2304.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2463.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4418.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2348.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2326.17,"additional_payer_notes":"APC"}]}]},{"description":"Cytog const alys interrog","code_information":[{"code":"0209U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":747.79,"maximum":1569.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":842.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":810.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":747.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":787.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":875.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1569.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":834.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":826.51,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis tst antb ia quan","code_information":[{"code":"0210U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.70,"maximum":37.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan-tum dna&rna gnrj seq","code_information":[{"code":"0211U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8032.25,"maximum":16861.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9046.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8708.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8032.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8455.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8793.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9401.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16861.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8962.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8877.75,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds gen dna alys proband","code_information":[{"code":"0212U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5201.44,"maximum":10919.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5858.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5639.46,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5201.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5475.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5694.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6088.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10919.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5803.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5748.96,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds gen dna alys ea comp","code_information":[{"code":"0213U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.45,"maximum":5404.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2899.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2791.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2574.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2709.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2818.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3013.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5404.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2872.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2845.45,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds xom dna alys proband","code_information":[{"code":"0214U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4963.37,"maximum":10419.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5590.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5381.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4963.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5224.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5433.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10419.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5538.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.83,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds xom dna alys ea comp","code_information":[{"code":"0215U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2445.92,"maximum":5134.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2754.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2651.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2445.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2574.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2677.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2863.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5134.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2729.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2703.38,"additional_payer_notes":"APC"}]}]},{"description":"Neuro inh ataxia dna 12 com","code_information":[{"code":"0216U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1460.17,"maximum":3065.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1644.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1583.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1460.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1537.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1598.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1709.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3065.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1629.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1613.87,"additional_payer_notes":"APC"}]}]},{"description":"Neuro inh ataxia dna 51 gene","code_information":[{"code":"0217U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2088.43,"maximum":4384.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2352.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2264.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2088.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2198.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2286.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2444.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4384.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2330.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2308.27,"additional_payer_notes":"APC"}]}]},{"description":"Neuro musc dys dmd seq alys","code_information":[{"code":"0218U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2165.05,"maximum":4545.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2438.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2347.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2165.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2279.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2370.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2534.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4545.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2415.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2392.95,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt hiv gnrj seq alys","code_information":[{"code":"0219U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":688.75,"maximum":1445.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":775.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":746.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":688.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":725.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":754.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":806.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1445.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":768.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":761.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca ai assmt 12 feat","code_information":[{"code":"0220U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.94,"maximum":1408.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":670.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":785.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1408.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":741.56,"additional_payer_notes":"APC"}]}]},{"description":"Abo gnotyp next gnrj seq abo","code_information":[{"code":"0221U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Rhd&rhce gntyp next gnrj seq","code_information":[{"code":"0222U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds 22 trgt sars-cov-2","code_information":[{"code":"0223U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Antibody sars-cov-2 titer(s)","code_information":[{"code":"0224U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.86,"maximum":102.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.0,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds dna&rna 21 sarscov2","code_information":[{"code":"0225U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Svnt sarscov2 elisa plsm srm","code_information":[{"code":"0226U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.17,"maximum":84.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.39,"additional_payer_notes":"APC"}]}]},{"description":"Rx asy prsmv 30+rx/metablt","code_information":[{"code":"0227U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.03,"maximum":123.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":123.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.25,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ma molec prfl alg","code_information":[{"code":"0228U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.38,"maximum":345.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":185.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":179.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":345.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":181.68,"additional_payer_notes":"APC"}]}]},{"description":"Bcat1 promoter mthyltn alys","code_information":[{"code":"0229U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":364.8,"maximum":765.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":364.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":384.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":399.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":427.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":765.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":407.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":403.2,"additional_payer_notes":"APC"}]}]},{"description":"Ar full sequence analysis","code_information":[{"code":"0230U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":286.28,"maximum":600.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":600.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.42,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a full gene analysis","code_information":[{"code":"0231U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":803.96,"maximum":1687.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":803.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":880.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":941.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1687.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":888.58,"additional_payer_notes":"APC"}]}]},{"description":"Cstb full gene analysis","code_information":[{"code":"0232U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene analysis","code_information":[{"code":"0233U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 full gene analysis","code_information":[{"code":"0234U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":501.48,"maximum":1052.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":564.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.71,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":527.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":586.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1052.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":559.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":554.26,"additional_payer_notes":"APC"}]}]},{"description":"Pten full gene analysis","code_information":[{"code":"0235U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.0,"maximum":1196.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":667.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1196.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.0,"additional_payer_notes":"APC"}]}]},{"description":"Smn1&smn2 full gene analysis","code_information":[{"code":"0236U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":572.56,"maximum":1201.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":644.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":620.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":572.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":670.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1201.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":638.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":632.84,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnlpthy gen seq pnl","code_information":[{"code":"0237U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.66,"maximum":1166.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":555.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":650.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1166.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc lnch syn gen dna seq aly","code_information":[{"code":"0238U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.66,"maximum":1166.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":555.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":650.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1166.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.14,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 311+","code_information":[{"code":"0239U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3325.0,"maximum":6980.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3325.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3892.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6980.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"}]}]},{"description":"Trgt gen seq alys pnl 55-74","code_information":[{"code":"0242U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4750.0,"maximum":9971.5,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5350.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5150.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4750.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5000.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5200.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5560.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9971.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5300.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5250.0,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe biochem assay pgf alg","code_information":[{"code":"0243U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.19,"maximum":128.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.63,"additional_payer_notes":"APC"}]}]},{"description":"Onc solid orgn dna 257 genes","code_information":[{"code":"0244U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3325.0,"maximum":6980.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3325.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3892.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6980.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr mut alys 10 gen&37","code_information":[{"code":"0245U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1202.77,"maximum":2524.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1354.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1304.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1202.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1266.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1316.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1407.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2524.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1342.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1329.37,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gnotyp 16 bld groups","code_information":[{"code":"0246U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.0,"maximum":1435.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":770.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":684.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":800.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1435.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":763.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.0,"additional_payer_notes":"APC"}]}]},{"description":"Ob prtrm brth ibp4 shbg meas","code_information":[{"code":"0247U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.5,"maximum":1495.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":834.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1495.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc brn sphrd cll 12 rx pnl","code_information":[{"code":"0248U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2882.17,"maximum":6050.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3246.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2882.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3155.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6050.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst alys 32 phsprtn alg","code_information":[{"code":"0249U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2108.17,"maximum":4425.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2374.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2285.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2108.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2219.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2307.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2467.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4425.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2352.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2330.09,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld org neo dna 505 gene","code_information":[{"code":"0250U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Hepcidin-25 elisa serum/plsm","code_information":[{"code":"0251U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneuploidy str alys dna","code_information":[{"code":"0252U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Rprdtve med rna gen prfl 238","code_information":[{"code":"0253U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3001.45,"maximum":6300.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3380.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3254.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3001.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3159.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3285.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3513.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6300.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3348.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3317.39,"additional_payer_notes":"APC"}]}]},{"description":"Reprdtve med alys 24 chrmsm","code_information":[{"code":"0254U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Andrology infertility assmt","code_information":[{"code":"0255U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.02,"maximum":63.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.18,"additional_payer_notes":"APC"}]}]},{"description":"Tma/tmao prfl ms/ms ur alg","code_information":[{"code":"0256U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":151.95,"maximum":318.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":171.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":318.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.95,"additional_payer_notes":"APC"}]}]},{"description":"Vlcad leuk nzm actv whl bld","code_information":[{"code":"0257U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":676.85,"maximum":1420.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":762.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":733.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.85,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":740.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":792.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1420.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":755.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":748.09,"additional_payer_notes":"APC"}]}]},{"description":"Ai psor mrna 50-100 gen alg","code_information":[{"code":"0258U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3491.25,"maximum":7329.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3932.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3785.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3491.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3822.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4086.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7329.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3895.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3858.75,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd nuc mrs meas gfr","code_information":[{"code":"0259U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.07,"maximum":105.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":105.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.35,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds id opt genome mapg","code_information":[{"code":"0260U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.35,"maximum":2519.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1200.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1405.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2519.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1326.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca img alys w/ai","code_information":[{"code":"0261U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2387.59,"maximum":5012.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2689.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2588.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2387.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2513.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2613.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2794.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5012.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2664.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2638.91,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum rt-pcr 7 gen","code_information":[{"code":"0262U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3040.0,"maximum":6381.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3424.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3296.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3040.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3200.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3328.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3558.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6381.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3392.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3360.0,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd meas 16 c metblt","code_information":[{"code":"0263U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.5,"maximum":1495.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":834.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1495.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.5,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds id opt genome mapg","code_information":[{"code":"0264U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.35,"maximum":2519.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1200.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1405.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2519.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1326.71,"additional_payer_notes":"APC"}]}]},{"description":"Rar do whl gn&mtcdrl dna als","code_information":[{"code":"0265U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5202.01,"maximum":10920.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5859.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5640.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5202.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5475.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5694.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6089.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10920.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5804.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5749.59,"additional_payer_notes":"APC"}]}]},{"description":"Unxpl cnst hrtbl do gn xprsn","code_information":[{"code":"0266U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3040.0,"maximum":6381.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3424.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3296.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3040.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3200.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3328.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3558.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6381.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3392.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3360.0,"additional_payer_notes":"APC"}]}]},{"description":"Rare do id opt gen mapg&seq","code_information":[{"code":"0267U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6402.36,"maximum":13440.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7211.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6941.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6402.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6739.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7008.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7494.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13440.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7143.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7076.3,"additional_payer_notes":"APC"}]}]},{"description":"Hem ahus gen seq alys 15 gen","code_information":[{"code":"0268U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem aut dm cgen trmbctpna 14","code_information":[{"code":"0269U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem cgen coagj do 20 genes","code_information":[{"code":"0270U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem cgen neutropenia 23 gen","code_information":[{"code":"0271U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem genetic bld do 51 genes","code_information":[{"code":"0272U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen hyprfibrnlysis 8 gen","code_information":[{"code":"0273U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen pltlt do 43 genes","code_information":[{"code":"0274U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem heprn nduc trmbctpna srm","code_information":[{"code":"0275U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.45,"maximum":36.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.29,"additional_payer_notes":"APC"}]}]},{"description":"Hem inh thrombocytopenia 23","code_information":[{"code":"0276U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2326.13,"maximum":4883.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2326.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2722.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4883.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2570.99,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen pltlt funcj do 31","code_information":[{"code":"0277U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem gen thrombosis 12 genes","code_information":[{"code":"0278U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":577.76,"maximum":1212.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":650.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":626.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":577.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":632.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1212.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":638.58,"additional_payer_notes":"APC"}]}]},{"description":"Hem vw factor&clgn iii bndg","code_information":[{"code":"0279U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.95,"maximum":22.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Hem vw factor&clgn iv bndg","code_information":[{"code":"0280U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Hem vwd propeptide ag lvl","code_information":[{"code":"0281U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Rbc dna gntyp 12 bld grp gen","code_information":[{"code":"0282U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":684.0,"maximum":1435.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":770.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":684.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":800.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1435.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":763.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":756.0,"additional_payer_notes":"APC"}]}]},{"description":"Vw factor type 2b eval plsm","code_information":[{"code":"0283U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.48,"maximum":36.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"}]}]},{"description":"Vw factor type 2n eval plsm","code_information":[{"code":"0284U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Onc rsps radj cll fr dna tox","code_information":[{"code":"0285U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.14,"maximum":884.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":474.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":456.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.14,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":443.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":461.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":492.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":884.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":469.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":465.48,"additional_payer_notes":"APC"}]}]},{"description":"Cep72 nudt15&tpmt gene alys","code_information":[{"code":"0286U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":127.42,"maximum":267.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":267.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":140.84,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr dna&mrna 112 genes","code_information":[{"code":"0287U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3420.0,"maximum":7179.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4003.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7179.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3780.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung mrna quan pcr 11&3","code_information":[{"code":"0288U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alzheimer mrna 24 gen","code_information":[{"code":"0289U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Pain mgmt mrna gen xprsn 36","code_information":[{"code":"0290U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Psyc mood do mrna 144 genes","code_information":[{"code":"0291U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1667.25,"maximum":3500.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1877.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1667.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1825.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1951.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1860.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1842.75,"additional_payer_notes":"APC"}]}]},{"description":"Psyc strs do mrna 72 genes","code_information":[{"code":"0292U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1667.25,"maximum":3500.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1877.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1667.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1825.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1951.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1860.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1842.75,"additional_payer_notes":"APC"}]}]},{"description":"Psyc suicidal idea mrna 54","code_information":[{"code":"0293U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst dux carc 7 proteins","code_information":[{"code":"0295U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5163.25,"maximum":10839.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5815.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5598.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5163.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5435.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5652.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6043.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10839.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5761.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5706.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc orl&/orop ca 20 mlc feat","code_information":[{"code":"0296U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1852.5,"maximum":3888.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1852.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2168.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3888.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2047.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen seq dna","code_information":[{"code":"0297U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl trns seq rna","code_information":[{"code":"0298U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen opt mapg","code_information":[{"code":"0299U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.06,"maximum":3715.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1993.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1919.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1770.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1937.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2071.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3715.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1975.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1956.38,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum whl gen seq&opt","code_information":[{"code":"0300U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3973.97,"maximum":8342.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4475.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4308.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3973.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4183.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4350.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4651.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8342.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4434.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4392.29,"additional_payer_notes":"APC"}]}]},{"description":"Iadna bartonella ddpcr","code_information":[{"code":"0301U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.58,"maximum":523.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":273.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":292.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":523.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":278.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":275.86,"additional_payer_notes":"APC"}]}]},{"description":"Iadna brtnla ddpcr flwg liq","code_information":[{"code":"0302U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":343.30,"maximum":720.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":386.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":372.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":361.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":401.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":720.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":379.44,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc ads whl bld hypoxic","code_information":[{"code":"0303U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2091.54,"maximum":4390.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2355.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2267.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2091.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2201.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2289.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4390.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2333.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2311.7,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc ads whl bld normoxic","code_information":[{"code":"0304U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1972.01,"maximum":4139.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2221.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2138.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1972.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2075.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2158.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2308.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4139.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2200.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2179.59,"additional_payer_notes":"APC"}]}]},{"description":"Hem rbc fnclty&dfrm shr strs","code_information":[{"code":"0305U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":629.45,"maximum":1321.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":708.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":682.46,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":629.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":662.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":689.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":736.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1321.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":695.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd nxt-gnrj alys 1st","code_information":[{"code":"0306U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3684.53,"maximum":7734.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4149.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3994.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3684.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3878.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4033.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4312.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7734.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4111.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4072.37,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd nxt-gnrj alys sbsq","code_information":[{"code":"0307U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":754.77,"maximum":1584.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":850.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":754.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":794.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":826.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":883.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1584.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":842.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":834.21,"additional_payer_notes":"APC"}]}]},{"description":"Crd cad alys 3 prtn plsm alg","code_information":[{"code":"0308U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.21,"maximum":779.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.29,"additional_payer_notes":"APC"}]}]},{"description":"Crd cv ds aly 4 prtn plm alg","code_information":[{"code":"0309U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.21,"maximum":779.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.29,"additional_payer_notes":"APC"}]}]},{"description":"Ped vsclts kd alys 3 bmrks","code_information":[{"code":"0310U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.21,"maximum":779.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.29,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct quan antmcrb sc","code_information":[{"code":"0311U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.68,"maximum":16.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.48,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 8 igg autoant","code_information":[{"code":"0312U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.62,"maximum":1676.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":798.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":934.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1676.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":882.68,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrs dna&mrna seq 74","code_information":[{"code":"0313U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3420.0,"maximum":7179.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4003.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7179.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3780.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 35 gene","code_information":[{"code":"0314U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1852.5,"maximum":3888.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2086.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2008.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1852.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2028.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2168.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3888.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2067.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2047.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan sq cll ca mrna 40","code_information":[{"code":"0315U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8075.0,"maximum":16951.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9095.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8755.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8075.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8500.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8840.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9452.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16951.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9010.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8925.0,"additional_payer_notes":"APC"}]}]},{"description":"B brgdrferi lyme ds ospa evl","code_information":[{"code":"0316U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.73,"maximum":37.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung ca 4-prb fish assay","code_information":[{"code":"0317U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1928.5,"maximum":4048.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2172.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2090.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1928.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2030.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2111.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2257.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4048.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2151.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2131.5,"additional_payer_notes":"APC"}]}]},{"description":"Ped whl gen mthyltn alys 50+","code_information":[{"code":"0318U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.96,"maximum":3530.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1894.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1823.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1681.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1770.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1841.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1968.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3530.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1876.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1859.0,"additional_payer_notes":"APC"}]}]},{"description":"Neph rna pretrnspl perph bld","code_information":[{"code":"0319U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2517.5,"maximum":5284.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2835.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2729.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2517.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2650.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2756.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2946.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5284.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2809.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2782.5,"additional_payer_notes":"APC"}]}]},{"description":"Neph rna psttrnspl perph bld","code_information":[{"code":"0320U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2517.5,"maximum":5284.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2835.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2729.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2517.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2650.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2756.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2946.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5284.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2809.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2782.5,"additional_payer_notes":"APC"}]}]},{"description":"Iadna gu pthgn 20bct&fng org","code_information":[{"code":"0321U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":603.10,"maximum":1266.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":603.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":660.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":705.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1266.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":672.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":666.58,"additional_payer_notes":"APC"}]}]},{"description":"Neuro asd meas 14 acyl carn","code_information":[{"code":"0322U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.5,"maximum":1495.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":834.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1495.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.5,"additional_payer_notes":"APC"}]}]},{"description":"Iadna cns pthgn next gen seq","code_information":[{"code":"0323U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2019.89,"maximum":4240.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2275.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2019.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2211.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2364.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4240.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2253.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2232.51,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay 120+ rx&metablt","code_information":[{"code":"0328U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.71,"maximum":228.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":228.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.15,"additional_payer_notes":"APC"}]}]},{"description":"Iadna vag pthgn panel 27 org","code_information":[{"code":"0330U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan tum gen prflg 8 dna","code_information":[{"code":"0332U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1084.96,"maximum":2277.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1222.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1176.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1084.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1142.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1187.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2277.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1210.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1199.16,"additional_payer_notes":"APC"}]}]},{"description":"Onc lvr surveilanc hcc cfdna","code_information":[{"code":"0333U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":629.20,"maximum":1320.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":708.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":682.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":629.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":662.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":688.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":736.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1320.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":695.44,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld orgn tgsa dna 84/+","code_information":[{"code":"0334U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3325.0,"maximum":6980.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3325.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3892.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6980.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq fetal","code_information":[{"code":"0335U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4963.37,"maximum":10419.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5590.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5381.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4963.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5224.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5433.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5809.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10419.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5538.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5485.83,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq bld/slv","code_information":[{"code":"0336U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2445.92,"maximum":5134.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2754.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2651.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2445.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2574.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2677.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2863.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5134.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2729.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2703.38,"additional_payer_notes":"APC"}]}]},{"description":"Onc plsm cell do&myeloma id","code_information":[{"code":"0337U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2313.25,"maximum":4856.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2313.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2707.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4856.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2556.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum crcg tum cl slct","code_information":[{"code":"0338U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2313.25,"maximum":4856.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2313.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2707.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4856.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2556.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna hoxc6 & dlx1","code_information":[{"code":"0339U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan ca alys mrd plasma","code_information":[{"code":"0340U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3410.5,"maximum":7159.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3841.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3697.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3410.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3590.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3733.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3992.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7159.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3805.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3769.5,"additional_payer_notes":"APC"}]}]},{"description":"Ftl aneup dna seq cmpr alys","code_information":[{"code":"0341U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1805.19,"maximum":3789.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2033.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1957.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1805.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1900.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1976.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2113.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3789.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2014.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1995.21,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 xom aly 442 sncrna","code_information":[{"code":"0343U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Hep nafld semiq evl 28 lipid","code_information":[{"code":"0344U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":752.56,"maximum":1579.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":847.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":815.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":752.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":792.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":823.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":880.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1579.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":839.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":831.78,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genom alys pnl 15 gen","code_information":[{"code":"0345U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.29,"maximum":2664.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1485.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2664.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1402.89,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 16 gen alys","code_information":[{"code":"0347U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.29,"maximum":2664.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1485.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2664.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1402.89,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 25 gen alys","code_information":[{"code":"0348U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":705.16,"maximum":1480.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":794.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":764.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":705.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":825.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1480.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":786.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.38,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 27gen rx ia","code_information":[{"code":"0349U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":705.16,"maximum":1480.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":794.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":764.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":705.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":742.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":771.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":825.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1480.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":786.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":779.38,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab/pcx dna 27 gen alys","code_information":[{"code":"0350U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.29,"maximum":2664.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1485.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2664.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1402.89,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct/viral trail ip10","code_information":[{"code":"0351U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.48,"maximum":519.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":519.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.53,"additional_payer_notes":"APC"}]}]},{"description":"Apol1 risk variants","code_information":[{"code":"0355U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Onc orop 17 dna ddpcr alg","code_information":[{"code":"0356U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1710.0,"maximum":3589.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1926.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1854.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1710.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1800.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1872.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2001.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3589.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1908.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1890.0,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alys b-amyl 1-42&1-40","code_information":[{"code":"0358U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.48,"maximum":519.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":519.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.53,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca alys all psa","code_information":[{"code":"0359U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung elisa 7 autoant alg","code_information":[{"code":"0360U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.62,"maximum":1676.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":798.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":934.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1676.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":882.68,"additional_payer_notes":"APC"}]}]},{"description":"Onc pap thyr ca rna 82&10","code_information":[{"code":"0362U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3420.0,"maximum":7179.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4003.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7179.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3780.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl mrna 5 gen alg","code_information":[{"code":"0363U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo gen seq alys alg","code_information":[{"code":"0364U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1906.89,"maximum":4003.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2147.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2067.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1906.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2007.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2087.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2232.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4003.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2127.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2107.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 prb bldr ca","code_information":[{"code":"0365U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":852.15,"maximum":1788.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":852.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.85,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 prb recr bldr ca","code_information":[{"code":"0366U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":852.15,"maximum":1788.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":852.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.85,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr 10 flwg trurl rescj","code_information":[{"code":"0367U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":857.07,"maximum":1799.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":965.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":929.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":857.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":902.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":938.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1003.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1799.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":956.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":947.29,"additional_payer_notes":"APC"}]}]},{"description":"Iadna gu pthgn semiq dna16&1","code_information":[{"code":"0371U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds gu pthgn arg detcj","code_information":[{"code":"0372U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovrn bchm asy 7 prtn alg","code_information":[{"code":"0375U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":852.15,"maximum":1788.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":852.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.85,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca img alys 128","code_information":[{"code":"0376U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.94,"maximum":1408.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":670.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":785.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1408.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":741.56,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds quan advsrm/plsm lprtn","code_information":[{"code":"0377U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.20,"maximum":94.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":94.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.96,"additional_payer_notes":"APC"}]}]},{"description":"Rfc1 repeat xpnsj vrnt alys","code_information":[{"code":"0378U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap sl or neo dna523&rna55","code_information":[{"code":"0379U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3124.08,"maximum":6558.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3518.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3656.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6558.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3485.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3452.94,"additional_payer_notes":"APC"}]}]},{"description":"Maple syrup ur ds mntr quan","code_information":[{"code":"0381U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.91,"maximum":87.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.91,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.33,"additional_payer_notes":"APC"}]}]},{"description":"Hyprphenylalninmia mntr quan","code_information":[{"code":"0382U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.06,"maximum":102.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.22,"additional_payer_notes":"APC"}]}]},{"description":"Tyrosinemia typ i mntr quan","code_information":[{"code":"0383U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.45,"maximum":103.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":103.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.65,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd rsk hi stg kdn ds","code_information":[{"code":"0384U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.5,"maximum":1495.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":834.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1495.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.5,"additional_payer_notes":"APC"}]}]},{"description":"Neph ckd alg rsk dbtc kdn ds","code_information":[{"code":"0385U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.21,"maximum":779.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.29,"additional_payer_notes":"APC"}]}]},{"description":"Onc mlnma ambra1&amlo","code_information":[{"code":"0387U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":901.08,"maximum":1891.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1014.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":976.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":901.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":948.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":986.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1054.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1891.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1005.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":995.92,"additional_payer_notes":"APC"}]}]},{"description":"Onc nonsm cll lng ca 37 gen","code_information":[{"code":"0388U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3325.0,"maximum":6980.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3745.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3605.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3325.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3640.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3892.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6980.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3710.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3675.0,"additional_payer_notes":"APC"}]}]},{"description":"Ped fbrl kd ifi27&mcemp1 rna","code_information":[{"code":"0389U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.69,"maximum":140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":140.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.71,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe kdr eng&rbp4 ia alg","code_information":[{"code":"0390U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.19,"maximum":128.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.63,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum dna&rna 437 gen","code_information":[{"code":"0391U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3420.0,"maximum":7179.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4003.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7179.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3780.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab genrx ia 16 genes","code_information":[{"code":"0392U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.29,"maximum":2664.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1485.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2664.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1402.89,"additional_payer_notes":"APC"}]}]},{"description":"Neu prksn msfl ?-syncln prtn","code_information":[{"code":"0393U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":513.94,"maximum":1078.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":513.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":562.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1078.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":573.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":568.04,"additional_payer_notes":"APC"}]}]},{"description":"Pfas 16 pfas compnd lc ms/ms","code_information":[{"code":"0394U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.80,"maximum":396.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":396.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.68,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng multiomics plsm alg","code_information":[{"code":"0395U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":757.58,"maximum":1590.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":853.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":821.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":757.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":797.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":829.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":886.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1590.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":837.32,"additional_payer_notes":"APC"}]}]},{"description":"Gi baret esph dna mthyln aly","code_information":[{"code":"0398U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1667.25,"maximum":3500.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1877.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1807.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1667.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1755.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1825.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1951.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3500.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1860.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1842.75,"additional_payer_notes":"APC"}]}]},{"description":"Neuro cere folate defncy srm","code_information":[{"code":"0399U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.0,"maximum":598.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":321.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":312.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":598.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":318.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":315.0,"additional_payer_notes":"APC"}]}]},{"description":"Crd c hrt ds 9 gen 12 vrnts","code_information":[{"code":"0401U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":465.20,"maximum":976.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":523.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":504.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":465.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":489.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":509.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":544.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":976.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":519.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":514.16,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt sti mult amp prb tq","code_information":[{"code":"0402U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna 18 gen dre ur","code_information":[{"code":"0403U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst semiq meas thym kn","code_information":[{"code":"0404U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.81,"maximum":644.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":306.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":359.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":644.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.11,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc 59 mthltn blk mrk","code_information":[{"code":"0405U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1681.96,"maximum":3530.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1894.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1823.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1681.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1770.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1841.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1968.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3530.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1876.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1859.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc lung flow cytmtry 5 mrk","code_information":[{"code":"0406U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Neph dbtc ckd mult eclia alg","code_information":[{"code":"0407U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":902.5,"maximum":1894.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1016.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":978.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":902.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":988.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1056.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1894.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1007.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":997.5,"additional_payer_notes":"APC"}]}]},{"description":"Iaad blk ac wv bsnsr sarscv2","code_information":[{"code":"0408U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":28.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum dna 80 & rna 36","code_information":[{"code":"0409U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc dna whl gn seq 5-","code_information":[{"code":"0410U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1102.0,"maximum":2313.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1102.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1289.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2313.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1218.0,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genom alys pnl 15 gen","code_information":[{"code":"0411U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.29,"maximum":2664.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1485.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2664.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1402.89,"additional_payer_notes":"APC"}]}]},{"description":"Beta amyloid a?42/40 imprcip","code_information":[{"code":"0412U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.5,"maximum":1495.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":834.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1495.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo opt gen mapg dna","code_information":[{"code":"0413U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.35,"maximum":2519.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1200.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1405.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2519.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1326.71,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng aug alg aly whl sld8","code_information":[{"code":"0414U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.94,"maximum":1408.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":670.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":785.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1408.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":741.56,"additional_payer_notes":"APC"}]}]},{"description":"Cv ds acs bld alg 5 yr score","code_information":[{"code":"0415U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.21,"maximum":779.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.29,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds alys 335 nuc genes","code_information":[{"code":"0417U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2700.40,"maximum":5668.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3041.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2927.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2700.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2842.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2956.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3160.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5668.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3013.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2984.66,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst aug alg aly whl sl8","code_information":[{"code":"0418U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.94,"maximum":1408.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":670.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":785.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1408.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":741.56,"additional_payer_notes":"APC"}]}]},{"description":"Nrpsyc gen seq vrnt aly 13","code_information":[{"code":"0419U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1269.29,"maximum":2664.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1429.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1376.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1336.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1389.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1485.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2664.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1416.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1402.89,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl mrna xprsn 6 snp","code_information":[{"code":"0420U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1261.90,"maximum":2649.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1421.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1368.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1261.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1328.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1381.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1477.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2649.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1408.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1394.74,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan solid tum alys dna","code_information":[{"code":"0422U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1846.05,"maximum":3875.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2079.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2001.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1846.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1943.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2020.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2160.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3875.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2059.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2040.37,"additional_payer_notes":"APC"}]}]},{"description":"Psyc genomic alys pnl 26 gen","code_information":[{"code":"0423U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 xom alys 53 sncrna","code_information":[{"code":"0424U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Genom rpd seq alys ea cmprtr","code_information":[{"code":"0425U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3889.67,"maximum":8165.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4381.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4217.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3889.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4094.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4258.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4552.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8165.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4340.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4299.11,"additional_payer_notes":"APC"}]}]},{"description":"Genome ultra-rapid seq alys","code_information":[{"code":"0426U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7203.09,"maximum":15121.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8112.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7203.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7885.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8431.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15121.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8037.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7961.31,"additional_payer_notes":"APC"}]}]},{"description":"Monocyte dstrbj wdth whl bld","code_information":[{"code":"0427U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.26,"maximum":8.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"}]}]},{"description":"Hpv orop swab 14 hi-risk typ","code_information":[{"code":"0429U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Gi malabs aat calpro pncrtc","code_information":[{"code":"0430U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.46,"maximum":122.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.62,"additional_payer_notes":"APC"}]}]},{"description":"Gly rcptr alpha1 igg srm/csf","code_information":[{"code":"0431U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.74,"maximum":72.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.4,"additional_payer_notes":"APC"}]}]},{"description":"Klhl11 antb sr/csf asy qual","code_information":[{"code":"0432U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.74,"maximum":72.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.4,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 5 dna reg mrk pcr","code_information":[{"code":"0433U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs vrnt alys 25","code_information":[{"code":"0434U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc chemo rx cytox csc 14 rx","code_information":[{"code":"0435U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2882.17,"maximum":6050.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3246.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2882.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3155.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6050.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng plsm alys 388 prtn","code_information":[{"code":"0436U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1429.03,"maximum":2999.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1609.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1549.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1429.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1504.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1564.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1672.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2999.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1594.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1579.45,"additional_payer_notes":"APC"}]}]},{"description":"Psyc anxiety do mrna 15 bmrk","code_information":[{"code":"0437U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs vrnt alys 33","code_information":[{"code":"0438U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Crd chd dna alys 5 snp 3 dna","code_information":[{"code":"0439U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":811.3,"maximum":1703.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":913.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":879.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":811.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":854.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":949.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1703.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":905.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7,"additional_payer_notes":"APC"}]}]},{"description":"Crd chd dna alys 10 snp 6dna","code_information":[{"code":"0440U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":811.3,"maximum":1703.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":913.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":879.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":811.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":854.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":888.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":949.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1703.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":905.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":896.7,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct fngl/viral semiq","code_information":[{"code":"0441U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":421.88,"maximum":885.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":475.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":457.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":421.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":444.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":461.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":493.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":885.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":470.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":466.28,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds respir nfctj mxa&crp","code_information":[{"code":"0442U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":82.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":82.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.45,"additional_payer_notes":"APC"}]}]},{"description":"Neurflmnt lt chn ultrsens ia","code_information":[{"code":"0443U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.42,"maximum":231.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":120.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":231.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.04,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld orgn neo tgsap 361","code_information":[{"code":"0444U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Abeta42 & ptau181 eclia csf","code_information":[{"code":"0445U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.48,"maximum":519.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":519.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.53,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 10 cytokine","code_information":[{"code":"0446U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.62,"maximum":1676.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":798.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":934.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1676.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":882.68,"additional_payer_notes":"APC"}]}]},{"description":"Ai ds sle alys 11 cytokine","code_information":[{"code":"0447U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.62,"maximum":1676.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":798.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":934.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1676.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":882.68,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr mthyl penk lte-qmsp","code_information":[{"code":"0452U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.4,"maximum":382.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":382.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201.6,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca cfdna qpcr asy","code_information":[{"code":"0453U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.4,"maximum":382.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":382.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201.6,"additional_payer_notes":"APC"}]}]},{"description":"U rare ds id opt genome mapg","code_information":[{"code":"0454U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.35,"maximum":2519.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1200.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1405.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2519.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1326.71,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agt sti mult amp prb ur","code_information":[{"code":"0455U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Pfas 9 cmpnd lcms/ms pls/sr","code_information":[{"code":"0457U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.80,"maximum":396.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":396.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.68,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst ca s100 a8&a9 elisa","code_information":[{"code":"0458U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.48,"maximum":519.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":519.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.53,"additional_payer_notes":"APC"}]}]},{"description":"Abeta42 & ttau eclia csf","code_information":[{"code":"0459U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.48,"maximum":519.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":519.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.53,"additional_payer_notes":"APC"}]}]},{"description":"Onc whl bld/bucc rtpcr 24gen","code_information":[{"code":"0460U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.23,"maximum":1828.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":981.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":953.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1019.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1828.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":972.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":962.93,"additional_payer_notes":"APC"}]}]},{"description":"Onc rxgenom alys rtpcr 24gen","code_information":[{"code":"0461U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.23,"maximum":1828.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":981.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":953.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1019.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1828.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":972.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":962.93,"additional_payer_notes":"APC"}]}]},{"description":"Melatonin lvl tst slp std7/9","code_information":[{"code":"0462U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Onc crvx mrna genxprsn 14bmk","code_information":[{"code":"0463U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct scr qrtsa dna mrk","code_information":[{"code":"0464U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":562.32,"maximum":1180.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":633.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":609.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":562.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":591.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":658.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1180.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":627.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":621.52,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl carc dna qmsp 2gen","code_information":[{"code":"0465U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.11,"maximum":3864.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2073.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1841.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2015.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2155.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3864.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2054.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2034.91,"additional_payer_notes":"APC"}]}]},{"description":"Crd cad dna gwas 564856 snp","code_information":[{"code":"0466U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.16,"maximum":688.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":328.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":345.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":359.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":384.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":688.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":366.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.7,"additional_payer_notes":"APC"}]}]},{"description":"Onc bldr dna ngs 60gen&aneup","code_information":[{"code":"0467U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1443.11,"maximum":3029.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1625.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1564.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1443.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1519.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1579.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1689.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3029.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1610.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1595.01,"additional_payer_notes":"APC"}]}]},{"description":"Hep nash mir34a5p ?2m ykl40","code_information":[{"code":"0468U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":239.12,"maximum":501.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":269.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":239.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":251.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":279.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":501.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":266.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.29,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq ftl samp","code_information":[{"code":"0469U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1138.04,"maximum":2389.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1281.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1233.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1138.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1197.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1245.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1332.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2389.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1257.84,"additional_payer_notes":"APC"}]}]},{"description":"Onc orop detcj mrd 8 dna hpv","code_information":[{"code":"0470U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.01,"maximum":1192.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":568.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":664.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1192.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":627.81,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrc ca 35 vrn kras&nras","code_information":[{"code":"0471U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Ca vi psp&sp1 antb sj?gren","code_information":[{"code":"0472U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.50,"maximum":55.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.3,"additional_payer_notes":"APC"}]}]},{"description":"Onc sld tum bld/slv 648 gene","code_information":[{"code":"0473U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4275.0,"maximum":8974.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4815.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4635.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4275.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4500.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4680.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5004.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8974.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4770.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4725.0,"additional_payer_notes":"APC"}]}]},{"description":"Hered pan ca gsap 88gene ngs","code_information":[{"code":"0474U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.75,"maximum":2600.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1238.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1449.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2600.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1369.15,"additional_payer_notes":"APC"}]}]},{"description":"Hered prst8 ca gsap 23 genes","code_information":[{"code":"0475U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.75,"maximum":2600.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1238.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1449.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2600.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1369.15,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab psyc 14gen&cyp2d6","code_information":[{"code":"0476U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab psy 14&cyp2d6 gn-rx","code_information":[{"code":"0477U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc nsclc dna&rna dpcr 9 gen","code_information":[{"code":"0478U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":525.34,"maximum":1102.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":591.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":569.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":525.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":552.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":575.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":614.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1102.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":586.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":580.64,"additional_payer_notes":"APC"}]}]},{"description":"Tau phosphorylated ptau217","code_information":[{"code":"0479U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds csf metag ngs alys","code_information":[{"code":"0480U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2019.89,"maximum":4240.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2275.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2189.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2019.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2126.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2211.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2364.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4240.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2253.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2232.51,"additional_payer_notes":"APC"}]}]},{"description":"Idh1 idh2&tert promoter ngs","code_information":[{"code":"0481U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":640.53,"maximum":1344.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":721.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":694.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":640.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":701.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":749.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1344.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":714.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":707.95,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe biochem asy sfit1&pigf","code_information":[{"code":"0482U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.38,"maximum":256.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":256.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.26,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds ng gyra s91f pt mut","code_information":[{"code":"0483U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds mgen 23s rrna pt mut","code_information":[{"code":"0484U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum cfdna&rna ngs gm","code_information":[{"code":"0485U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3467.01,"maximum":7278.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3904.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3758.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3467.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3649.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3795.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4058.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7278.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3868.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3831.95,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan sol tum ngs cfctdna","code_information":[{"code":"0486U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1562.04,"maximum":3279.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1759.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1693.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1562.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1644.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1710.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1828.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3279.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1742.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1726.46,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum cfcdna tgsap 84","code_information":[{"code":"0487U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan/uveal mlnma cd146","code_information":[{"code":"0490U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2313.25,"maximum":4856.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2313.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2707.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4856.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2556.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ctc slct er prtn","code_information":[{"code":"0491U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2313.25,"maximum":4856.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2313.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2707.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4856.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2556.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ctc slctn pd-l1","code_information":[{"code":"0492U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2313.25,"maximum":4856.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2605.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2508.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2313.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2435.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2532.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2707.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4856.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2581.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2556.75,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl med quan dd-cfdna ngs","code_information":[{"code":"0493U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2615.59,"maximum":5490.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2615.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2863.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3061.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5490.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2918.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2890.91,"additional_payer_notes":"APC"}]}]},{"description":"Rbc ag ftl rhd gene alys ngs","code_information":[{"code":"0494U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alys crcg plsm prt","code_information":[{"code":"0495U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct cfdna 8/7 genes","code_information":[{"code":"0496U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":461.57,"maximum":968.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":519.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":500.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":461.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":485.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":505.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":540.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":968.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":515.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":510.15,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 mrna rt-pcr 6 gene","code_information":[{"code":"0497U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ngs mut detc 43gen","code_information":[{"code":"0498U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1278.04,"maximum":2682.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1439.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1385.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1278.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1345.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1399.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1495.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2682.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1426.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1412.58,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct&lng dna ngs 8gene","code_information":[{"code":"0499U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.01,"maximum":1192.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":568.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":664.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1192.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":627.81,"additional_payer_notes":"APC"}]}]},{"description":"Autoinflam ds vexas synd dna","code_information":[{"code":"0500U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.63,"maximum":349.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":349.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184.17,"additional_payer_notes":"APC"}]}]},{"description":"Hpv e6/e7 mrk hi-rsk typ crv","code_information":[{"code":"0502U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Neuro alz ds ?amyl&tau prtn","code_information":[{"code":"0503U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":712.5,"maximum":1495.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":802.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":772.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":834.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1495.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":787.5,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds uti id 17 path orgs","code_information":[{"code":"0504U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds vag infctj id 32orgs","code_information":[{"code":"0505U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":645.78,"maximum":1355.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":645.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":679.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":755.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1355.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.76,"additional_payer_notes":"APC"}]}]},{"description":"Gi barretts esophgl cell 89","code_information":[{"code":"0506U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1841.11,"maximum":3864.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2073.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1996.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1841.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1938.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2015.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2155.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3864.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2054.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2034.91,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovr dna whole gen w/5hmc","code_information":[{"code":"0507U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1102.0,"maximum":2313.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1102.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1289.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2313.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1218.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc ca alg alys 16gen","code_information":[{"code":"0510U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":450.21,"maximum":945.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":507.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":488.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":473.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":492.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":526.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":945.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":502.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":497.61,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum 3dmicroenvir 36+","code_information":[{"code":"0511U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2882.17,"maximum":6050.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3246.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2882.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3155.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6050.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.55,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alys dgtz img msi","code_information":[{"code":"0512U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.94,"maximum":1408.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":670.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":785.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1408.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":741.56,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 alg alys msi&hrd","code_information":[{"code":"0513U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":670.94,"maximum":1408.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":755.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":727.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":670.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":734.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":785.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1408.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":748.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":741.56,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibd ia quan deter adl lvl","code_information":[{"code":"0514U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.64,"maximum":76.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.5,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibd ia quan deter ifx lvl","code_information":[{"code":"0515U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.64,"maximum":76.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.5,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab rxgenomic gnotyp 40","code_information":[{"code":"0516U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 80+ psyactiv rx","code_information":[{"code":"0517U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 90+ pn&mtl hlth","code_information":[{"code":"0518U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr meds p/d/a 110+","code_information":[{"code":"0519U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 200+ rx/sbsts","code_information":[{"code":"0520U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Rf iga&igm ccp antb sr-a ia","code_information":[{"code":"0521U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.21,"maximum":103.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":103.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"}]}]},{"description":"Ca vi psp&sp1 antb cl semiql","code_information":[{"code":"0522U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.48,"maximum":519.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":519.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.53,"additional_payer_notes":"APC"}]}]},{"description":"Onc soltum dna ngs snv 22gen","code_information":[{"code":"0523U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1284.49,"maximum":2696.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1446.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1392.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1284.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1352.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1406.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1503.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2696.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1433.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1419.69,"additional_payer_notes":"APC"}]}]},{"description":"Ob pe sflt-1/plgf ia srm/pls","code_information":[{"code":"0524U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.38,"maximum":256.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":256.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.26,"additional_payer_notes":"APC"}]}]},{"description":"Onc sphrd cell cul 11-rx pnl","code_information":[{"code":"0525U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2882.17,"maximum":6050.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3246.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2882.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3033.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3155.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3373.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6050.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3215.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3185.55,"additional_payer_notes":"APC"}]}]},{"description":"Hsv 1&2 vzv amp prb tq pthgn","code_information":[{"code":"0527U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Lrt iad 18bct/8vir&7arg rna","code_information":[{"code":"0528U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":603.10,"maximum":1266.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":603.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":660.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":705.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1266.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":672.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":666.58,"additional_payer_notes":"APC"}]}]},{"description":"Onc pan-sol tum ctdna 77 gen","code_information":[{"code":"0530U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whlgen&mitochdrl dna","code_information":[{"code":"0532U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4779.64,"maximum":10033.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5383.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4779.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5232.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5594.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10033.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5333.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5282.76,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab advrs gnotyp 16gens","code_information":[{"code":"0533U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Pfas lc-ms/ms plsm/srm quan","code_information":[{"code":"0535U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.03,"maximum":123.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":123.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.25,"additional_payer_notes":"APC"}]}]},{"description":"Rbcag ftl rhd pcr alys exon4","code_information":[{"code":"0536U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.4,"maximum":382.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":382.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201.6,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct ca cfdna >2500 dmr","code_information":[{"code":"0537U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1420.25,"maximum":2981.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1599.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1539.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1420.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1495.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1554.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1662.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2981.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1584.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1569.75,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ngts ffpe 600gen","code_information":[{"code":"0538U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2840.07,"maximum":5962.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3198.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2840.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3109.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3324.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5962.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3139.03,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tumor cfctdna 152gen","code_information":[{"code":"0539U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3124.08,"maximum":6558.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3518.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3656.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6558.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3485.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3452.94,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med quan dd-cfdna","code_information":[{"code":"0540U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2615.59,"maximum":5490.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2945.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2835.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2615.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2753.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2863.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3061.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5490.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2918.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2890.91,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum ngs dna 517 gens","code_information":[{"code":"0543U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2840.07,"maximum":5962.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3198.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2840.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3109.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3324.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5962.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3139.03,"additional_payer_notes":"APC"}]}]},{"description":"Achr antb id imfluor livecll","code_information":[{"code":"0545U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.84,"maximum":75.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.62,"additional_payer_notes":"APC"}]}]},{"description":"Ldns lrp4 antb imflr livecll","code_information":[{"code":"0546U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.84,"maximum":75.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.62,"additional_payer_notes":"APC"}]}]},{"description":"Neurflmnt lt chn cleia plsm","code_information":[{"code":"0547U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.42,"maximum":231.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":120.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":231.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.04,"additional_payer_notes":"APC"}]}]},{"description":"Gfap cleia plasma","code_information":[{"code":"0548U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.42,"maximum":231.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":120.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":231.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.04,"additional_payer_notes":"APC"}]}]},{"description":"Onc urthl dna mthyltd rt pcr","code_information":[{"code":"0549U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga embry te strux","code_information":[{"code":"0553U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga 24chrm te bx qc","code_information":[{"code":"0554U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Repr med pga embryonic te qc","code_information":[{"code":"0555U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds p-s dna&rna 12 trgts","code_information":[{"code":"0556U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv dna mrk vag fluid","code_information":[{"code":"0557U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.84,"maximum":524.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":292.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":524.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":276.14,"additional_payer_notes":"APC"}]}]},{"description":"Onc clrct elisa bf7 ag serum","code_information":[{"code":"0558U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.77,"maximum":41.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"}]}]},{"description":"Onc brs quan elisa bf9ag srm","code_information":[{"code":"0559U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.77,"maximum":41.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd gsa cfdna baseline","code_information":[{"code":"0560U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3684.53,"maximum":7734.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4149.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3994.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3684.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3878.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4033.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4312.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7734.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4111.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4072.37,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrd gsa cfdna subsequent","code_information":[{"code":"0561U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":754.77,"maximum":1584.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":850.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":754.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":794.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":826.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":883.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1584.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":842.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":834.21,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum tgsa 33gens snvs","code_information":[{"code":"0562U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.01,"maximum":1192.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":568.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":664.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1192.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":627.81,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds pthgn-sna 11vir&4bct","code_information":[{"code":"0563U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds pthgn-sna 10vir&4bct","code_information":[{"code":"0564U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Onc hcc ngs detc 6626epigalt","code_information":[{"code":"0565U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1102.0,"maximum":2313.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1102.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1289.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2313.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1218.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc lng qpcr-bsd alys 13dmrs","code_information":[{"code":"0566U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds whl gen seq srs&lrs","code_information":[{"code":"0567U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4779.64,"maximum":10033.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5383.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4779.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5232.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5594.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10033.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5333.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5282.76,"additional_payer_notes":"APC"}]}]},{"description":"Neurol dementia ?amyl ptau","code_information":[{"code":"0568U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":852.15,"maximum":1788.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":852.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.85,"additional_payer_notes":"APC"}]}]},{"description":"Neurol tbi alys gfap&uch-l1","code_information":[{"code":"0570U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.48,"maximum":519.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":519.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.53,"additional_payer_notes":"APC"}]}]},{"description":"Onc sol tum dna80&rna10g ngs","code_information":[{"code":"0571U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med lar rtpcr 4genes","code_information":[{"code":"0575U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":361.0,"maximum":757.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":406.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":391.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":361.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":380.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":422.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":757.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":399.0,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj med lar quan ddcfdna","code_information":[{"code":"0576U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3078.0,"maximum":6461.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3466.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3078.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3602.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6461.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3434.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc ovr serum alys 39 gps","code_information":[{"code":"0577U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mln rna qpcr 10gen","code_information":[{"code":"0578U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Nfro dbtc ckd elisa apoa4","code_information":[{"code":"0579U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":371.21,"maximum":779.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":418.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":406.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":434.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":779.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":410.29,"additional_payer_notes":"APC"}]}]},{"description":"Bbrgdrferi antb detc 24rprtn","code_information":[{"code":"0580U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.35,"maximum":34.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.07,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl med antb nohla 39trgt","code_information":[{"code":"0581U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.51,"maximum":649.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":348.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":338.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":362.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":649.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":345.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds rpd whlgen dna vrnts","code_information":[{"code":"0582U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7203.09,"maximum":15121.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8112.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7809.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7203.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7582.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7885.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8431.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15121.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8037.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7961.31,"additional_payer_notes":"APC"}]}]},{"description":"Rare ds rpd whlgen cmptr dna","code_information":[{"code":"0583U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3601.54,"maximum":7560.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4056.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3904.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3601.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3791.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3942.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4215.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7560.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4018.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3980.66,"additional_payer_notes":"APC"}]}]},{"description":"Neuro csf prion prtn qual","code_information":[{"code":"0584U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":513.94,"maximum":1078.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":578.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":557.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":513.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":540.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":562.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1078.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":573.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":568.04,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so neo cfdna 521 genes","code_information":[{"code":"0585U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Onc mrna gen xprsn 216 genes","code_information":[{"code":"0586U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Ther rx mntr 60-150rx&metabl","code_information":[{"code":"0587U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.71,"maximum":228.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":228.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.15,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bct/vir 32genes mrna","code_information":[{"code":"0588U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Pfas24cmpnd hi-perf lc-ms/ms","code_information":[{"code":"0589U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.80,"maximum":396.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":396.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.68,"additional_payer_notes":"APC"}]}]},{"description":"Onc prst8 ca 3prtns plsm srm","code_information":[{"code":"0591U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc hl neo dna tgs 417 genes","code_information":[{"code":"0592U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds gu pthgn dna 46trgt","code_information":[{"code":"0593U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":603.10,"maximum":1266.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":679.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":653.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":603.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":634.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":660.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":705.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1266.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":672.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":666.58,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds tfp vctrbrn&zoonotic","code_information":[{"code":"0595U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.84,"maximum":524.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":292.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":524.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":276.14,"additional_payer_notes":"APC"}]}]},{"description":"Gi ibs igg antb 18food items","code_information":[{"code":"0598U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.0,"maximum":598.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":321.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":312.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":598.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":318.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":315.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc pncrtc ca mult ia serum","code_information":[{"code":"0599U","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":852.15,"maximum":1788.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":852.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.85,"additional_payer_notes":"APC"}]}]},{"description":"Routine venipuncture","code_information":[{"code":"36415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.87,"maximum":18.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"}]}]},{"description":"Metabolic panel ionized ca","code_information":[{"code":"80047","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.04,"maximum":27.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"}]}]},{"description":"Metabolic panel total ca","code_information":[{"code":"80048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.04,"maximum":16.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.71,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.88,"additional_payer_notes":"APC"}]}]},{"description":"Electrolyte panel","code_information":[{"code":"80051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.66,"maximum":13.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.36,"additional_payer_notes":"APC"}]}]},{"description":"Comprehen metabolic panel","code_information":[{"code":"80053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.03,"maximum":21.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.09,"additional_payer_notes":"APC"}]}]},{"description":"Obstetric panel","code_information":[{"code":"80055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.42,"maximum":95.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":95.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.2,"additional_payer_notes":"APC"}]}]},{"description":"Lipid panel","code_information":[{"code":"80061","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.72,"maximum":26.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.06,"additional_payer_notes":"APC"}]}]},{"description":"Renal function panel","code_information":[{"code":"80069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.25,"maximum":17.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"}]}]},{"description":"Acute hepatitis panel","code_information":[{"code":"80074","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.25,"maximum":94.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":94.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.01,"additional_payer_notes":"APC"}]}]},{"description":"Hepatic function panel","code_information":[{"code":"80076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.76,"maximum":16.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"}]}]},{"description":"Obstetric panel","code_information":[{"code":"80081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.12,"maximum":149.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":149.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.6,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay acetaminophen","code_information":[{"code":"80143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.71,"maximum":37.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay adalimumab","code_information":[{"code":"80145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.64,"maximum":76.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of amikacin","code_information":[{"code":"80150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.33,"maximum":30.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.83,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay amiodarone","code_information":[{"code":"80151","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.71,"maximum":37.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay caffeine","code_information":[{"code":"80155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.64,"maximum":76.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay carbamazepine total","code_information":[{"code":"80156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.84,"maximum":29.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay carbamazepine free","code_information":[{"code":"80157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":26.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay cyclosporine","code_information":[{"code":"80158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.15,"maximum":36.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay clozapine","code_information":[{"code":"80159","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.14,"maximum":40.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.16,"additional_payer_notes":"APC"}]}]},{"description":"Asy carbamazepin 10,11-epxid","code_information":[{"code":"80161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.71,"maximum":37.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of digoxin total","code_information":[{"code":"80162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.62,"maximum":26.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay of digoxin free","code_information":[{"code":"80163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.62,"maximum":26.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay dipropylacetic acd tot","code_information":[{"code":"80164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.86,"maximum":27.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.22,"additional_payer_notes":"APC"}]}]},{"description":"Dipropylacetic acid free","code_information":[{"code":"80165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.86,"maximum":27.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.22,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay felbamate","code_information":[{"code":"80167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.71,"maximum":37.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ethosuximide","code_information":[{"code":"80168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.52,"maximum":32.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay everolimus","code_information":[{"code":"80169","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.04,"maximum":27.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gentamicin","code_information":[{"code":"80170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.56,"maximum":32.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant gabapentin","code_information":[{"code":"80171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.59,"maximum":43.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Haloperidol","code_information":[{"code":"80173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.99,"maximum":31.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quan lamotrigine","code_information":[{"code":"80175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":26.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lidocaine","code_information":[{"code":"80176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.96,"maximum":29.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quan levetiracetam","code_information":[{"code":"80177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":26.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lithium","code_information":[{"code":"80178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.28,"maximum":13.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay salicylate","code_information":[{"code":"80179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.71,"maximum":37.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quan mycophenolate","code_information":[{"code":"80180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.15,"maximum":36.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay flecainide","code_information":[{"code":"80181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.71,"maximum":37.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"}]}]},{"description":"Drug scrn quant oxcarbazepin","code_information":[{"code":"80183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":26.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenobarbital","code_information":[{"code":"80184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.54,"maximum":30.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenytoin total","code_information":[{"code":"80185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":26.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenytoin free","code_information":[{"code":"80186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.07,"maximum":27.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay posaconazole","code_information":[{"code":"80187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.75,"maximum":54.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of primidone","code_information":[{"code":"80188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.76,"maximum":33.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.09,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay itraconzaole","code_information":[{"code":"80189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.75,"maximum":54.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of procainamide","code_information":[{"code":"80190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.0,"maximum":119.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":119.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay of procainamide","code_information":[{"code":"80192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.91,"maximum":33.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay leflunomide","code_information":[{"code":"80193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.64,"maximum":76.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay of quinidine","code_information":[{"code":"80194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.87,"maximum":29.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sirolimus","code_information":[{"code":"80195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.04,"maximum":27.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tacrolimus","code_information":[{"code":"80197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.04,"maximum":27.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of theophylline","code_information":[{"code":"80198","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.43,"maximum":28.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.85,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant tiagabine","code_information":[{"code":"80199","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.75,"maximum":54.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tobramycin","code_information":[{"code":"80200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.32,"maximum":32.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay of topiramate","code_information":[{"code":"80201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.32,"maximum":23.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vancomycin","code_information":[{"code":"80202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.86,"maximum":27.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.22,"additional_payer_notes":"APC"}]}]},{"description":"Drug screen quant zonisamide","code_information":[{"code":"80203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":26.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay methotrexate","code_information":[{"code":"80204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.64,"maximum":76.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.5,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay rufinamide","code_information":[{"code":"80210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.75,"maximum":54.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"}]}]},{"description":"Drug asy hydroxychloroquine","code_information":[{"code":"80220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.71,"maximum":37.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay infliximab","code_information":[{"code":"80230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.64,"maximum":76.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.5,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay lacosamide","code_information":[{"code":"80235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.75,"maximum":54.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay vedolizumab","code_information":[{"code":"80280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.64,"maximum":76.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.5,"additional_payer_notes":"APC"}]}]},{"description":"Drug assay voriconazole","code_information":[{"code":"80285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.75,"maximum":54.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"}]}]},{"description":"Quantitative assay drug","code_information":[{"code":"80299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.71,"maximum":37.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv dir opt obs","code_information":[{"code":"80305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.97,"maximum":25.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.23,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv instrmnt","code_information":[{"code":"80306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.28,"maximum":34.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"}]}]},{"description":"Drug test prsmv chem anlyzr","code_information":[{"code":"80307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.03,"maximum":123.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":123.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.25,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.99,"maximum":65.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.25,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":82.61,"maximum":173.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":93.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":173.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91.31,"additional_payer_notes":"APC"}]}]},{"description":"Acth stimulation panel","code_information":[{"code":"80406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.35,"maximum":156.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":156.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.17,"additional_payer_notes":"APC"}]}]},{"description":"Aldosterone suppression eval","code_information":[{"code":"80408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.22,"maximum":250.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":250.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.78,"additional_payer_notes":"APC"}]}]},{"description":"Calcitonin stimul panel","code_information":[{"code":"80410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.35,"maximum":160.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":160.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.39,"additional_payer_notes":"APC"}]}]},{"description":"CRH stimulation panel","code_information":[{"code":"80412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":761.54,"maximum":1598.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":857.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":825.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":761.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":801.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":833.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":891.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1598.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":849.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":841.7,"additional_payer_notes":"APC"}]}]},{"description":"Testosterone response","code_information":[{"code":"80414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.06,"maximum":102.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.22,"additional_payer_notes":"APC"}]}]},{"description":"Estradiol response panel","code_information":[{"code":"80415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.10,"maximum":111.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":111.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.68,"additional_payer_notes":"APC"}]}]},{"description":"Renin stimulation panel","code_information":[{"code":"80416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.85,"maximum":417.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":223.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.85,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":417.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":219.79,"additional_payer_notes":"APC"}]}]},{"description":"Renin stimulation panel","code_information":[{"code":"80417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.79,"maximum":87.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.19,"additional_payer_notes":"APC"}]}]},{"description":"Pituitary evaluation panel","code_information":[{"code":"80418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":550.51,"maximum":1155.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":596.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":550.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":579.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1155.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":614.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":608.45,"additional_payer_notes":"APC"}]}]},{"description":"Dexamethasone panel","code_information":[{"code":"80420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":153.79,"maximum":322.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":153.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":322.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":171.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":169.97,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance panel","code_information":[{"code":"80422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.77,"maximum":91.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":91.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.37,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance panel","code_information":[{"code":"80424","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.98,"maximum":100.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":100.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.03,"additional_payer_notes":"APC"}]}]},{"description":"Gonadotropin hormone panel","code_information":[{"code":"80426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.99,"maximum":295.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":158.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":295.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":157.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":155.83,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone panel","code_information":[{"code":"80428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.36,"maximum":133.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":133.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.04,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone panel","code_information":[{"code":"80430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.86,"maximum":257.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":138.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":257.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.8,"additional_payer_notes":"APC"}]}]},{"description":"Insulin suppression panel","code_information":[{"code":"80432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.33,"maximum":330.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":170.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":157.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":184.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":330.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.89,"additional_payer_notes":"APC"}]}]},{"description":"Insulin tolerance panel","code_information":[{"code":"80434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":270.78,"maximum":568.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":304.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":296.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":316.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":568.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.28,"additional_payer_notes":"APC"}]}]},{"description":"Insulin tolerance panel","code_information":[{"code":"80435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.85,"maximum":205.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.09,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.85,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":107.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":205.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108.15,"additional_payer_notes":"APC"}]}]},{"description":"Metyrapone panel","code_information":[{"code":"80436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":86.60,"maximum":181.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":97.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":95.72,"additional_payer_notes":"APC"}]}]},{"description":"TRH stimulation panel","code_information":[{"code":"80438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.89,"maximum":100.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":100.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.93,"additional_payer_notes":"APC"}]}]},{"description":"TRH stimulation panel","code_information":[{"code":"80439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.85,"maximum":134.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.85,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":134.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.57,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis nonauto w/scope","code_information":[{"code":"81000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.82,"maximum":8.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.22,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis auto w/scope","code_information":[{"code":"81001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.01,"maximum":6.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.33,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis nonauto w/o scope","code_information":[{"code":"81002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.31,"maximum":6.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis auto w/o scope","code_information":[{"code":"81003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.14,"maximum":4.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.14,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.36,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis","code_information":[{"code":"81005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.06,"maximum":4.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.28,"additional_payer_notes":"APC"}]}]},{"description":"Urine screen for bacteria","code_information":[{"code":"81007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.48,"maximum":59.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.48,"additional_payer_notes":"APC"}]}]},{"description":"Microscopic exam of urine","code_information":[{"code":"81015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.90,"maximum":6.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.2,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis glass test","code_information":[{"code":"81020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.46,"maximum":9.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"}]}]},{"description":"Urine pregnancy test","code_information":[{"code":"81025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.18,"maximum":17.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"}]}]},{"description":"Urinalysis volume measure","code_information":[{"code":"81050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.46,"maximum":7.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.82,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-1 genotyping","code_information":[{"code":"81105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-2 genotyping","code_information":[{"code":"81106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-3 genotyping","code_information":[{"code":"81107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-4 genotyping","code_information":[{"code":"81108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-5 genotyping","code_information":[{"code":"81109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-6 genotyping","code_information":[{"code":"81110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-9 genotyping","code_information":[{"code":"81111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Hpa-15 genotyping","code_information":[{"code":"81112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Idh1 common variants","code_information":[{"code":"81120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.59,"maximum":385.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":385.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.91,"additional_payer_notes":"APC"}]}]},{"description":"Idh2 common variants","code_information":[{"code":"81121","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":281.00,"maximum":589.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":304.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":281.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":295.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":307.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":328.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":589.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":310.58,"additional_payer_notes":"APC"}]}]},{"description":"DMD dup/delet analysis","code_information":[{"code":"81161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":265.05,"maximum":556.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":298.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":287.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":279.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":556.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":295.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":292.95,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 seq & full dup/del","code_information":[{"code":"81162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1733.64,"maximum":3639.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1952.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1879.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1733.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1824.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1897.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2029.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3639.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1934.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1916.12,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 gene full seq alys","code_information":[{"code":"81163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":444.6,"maximum":933.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":500.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":482.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":444.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":486.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":520.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":933.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":496.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":491.4,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 gen ful dup/del alys","code_information":[{"code":"81164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.02,"maximum":1165.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":625.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":601.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":555.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":607.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":649.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1165.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":619.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":613.44,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene full seq alys","code_information":[{"code":"81165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene full dup/del alys","code_information":[{"code":"81166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":286.28,"maximum":600.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":600.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.42,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene full dup/del alys","code_information":[{"code":"81167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Ccnd1/igh translocation alys","code_information":[{"code":"81168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.94,"maximum":413.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":230.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":413.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.68,"additional_payer_notes":"APC"}]}]},{"description":"Abl1 gene","code_information":[{"code":"81170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.0,"maximum":598.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":321.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":312.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":598.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":318.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":315.0,"additional_payer_notes":"APC"}]}]},{"description":"Aff2 gene detc abnor alleles","code_information":[{"code":"81171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Aff2 gene charac alleles","code_information":[{"code":"81172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene full gene sequence","code_information":[{"code":"81173","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":286.28,"maximum":600.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":600.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.42,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene known famil variant","code_information":[{"code":"81174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Asxl1 full gene sequence","code_information":[{"code":"81175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":642.68,"maximum":1349.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":723.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":642.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":703.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":752.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1349.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":717.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":710.32,"additional_payer_notes":"APC"}]}]},{"description":"Asxl1 gene target seq alys","code_information":[{"code":"81176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.80,"maximum":482.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":258.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":229.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":241.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":251.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":482.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":254.0,"additional_payer_notes":"APC"}]}]},{"description":"Atn1 gene detc abnor alleles","code_information":[{"code":"81177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Atxn1 gene detc abnor allele","code_information":[{"code":"81178","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Atxn2 gene detc abnor allele","code_information":[{"code":"81179","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Atxn3 gene detc abnor allele","code_information":[{"code":"81180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Atxn7 gene detc abnor allele","code_information":[{"code":"81181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Atxn8os gen detc abnor allel","code_information":[{"code":"81182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Atxn10 gene detc abnor allel","code_information":[{"code":"81183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gen detc abnor allel","code_information":[{"code":"81184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gene full gene seq","code_information":[{"code":"81185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":803.96,"maximum":1687.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":803.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":880.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":941.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1687.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":888.58,"additional_payer_notes":"APC"}]}]},{"description":"Cacna1a gen known famil vrnt","code_information":[{"code":"81186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Cnbp gene detc abnor allele","code_information":[{"code":"81187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene detc abnor allele","code_information":[{"code":"81188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene full gene sequence","code_information":[{"code":"81189","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Cstb gene known famil vrnt","code_information":[{"code":"81190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk1 translocation analysis","code_information":[{"code":"81191","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.94,"maximum":413.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":230.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":413.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.68,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk2 translocation analysis","code_information":[{"code":"81192","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.94,"maximum":413.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":230.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":413.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.68,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk3 translocation analysis","code_information":[{"code":"81193","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.94,"maximum":413.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":230.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":413.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.68,"additional_payer_notes":"APC"}]}]},{"description":"Ntrk translocation analysis","code_information":[{"code":"81194","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":492.37,"maximum":1033.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":554.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":533.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":492.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":539.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":576.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1033.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":549.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":544.19,"additional_payer_notes":"APC"}]}]},{"description":"Cytog genom-wid alys hem mal","code_information":[{"code":"81195","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1770.06,"maximum":3715.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1993.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1919.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1770.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1863.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1937.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2071.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3715.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1975.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1956.38,"additional_payer_notes":"APC"}]}]},{"description":"Aspa gene","code_information":[{"code":"81200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.89,"maximum":94.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":94.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.61,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene full sequence","code_information":[{"code":"81201","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":741.0,"maximum":1555.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":834.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":803.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":741.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":811.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":867.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1555.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":826.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":819.0,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene known fam variants","code_information":[{"code":"81202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":266.0,"maximum":558.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":299.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":288.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":266.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":280.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":311.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":558.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":296.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.0,"additional_payer_notes":"APC"}]}]},{"description":"Apc gene dup/delet variants","code_information":[{"code":"81203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":190.0,"maximum":398.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":214.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":398.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":212.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":210.0,"additional_payer_notes":"APC"}]}]},{"description":"Ar gene charac alleles","code_information":[{"code":"81204","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Bckdhb gene","code_information":[{"code":"81205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.24,"maximum":189.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":189.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.74,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene major bp","code_information":[{"code":"81206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":155.76,"maximum":326.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":175.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":155.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":163.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":170.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":326.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":172.16,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene minor bp","code_information":[{"code":"81207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.60,"maximum":288.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":288.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":153.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.08,"additional_payer_notes":"APC"}]}]},{"description":"Bcr/abl1 gene other bp","code_information":[{"code":"81208","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":203.89,"maximum":428.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":229.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":223.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":238.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":428.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":227.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":225.35,"additional_payer_notes":"APC"}]}]},{"description":"Blm gene","code_information":[{"code":"81209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.34,"maximum":78.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"}]}]},{"description":"Braf gene","code_information":[{"code":"81210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.63,"maximum":349.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":349.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184.17,"additional_payer_notes":"APC"}]}]},{"description":"Brca1&2 185&5385&6174 var","code_information":[{"code":"81212","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":418.0,"maximum":877.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":470.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":453.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":418.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":440.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":457.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":489.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":877.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":466.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":462.0,"additional_payer_notes":"APC"}]}]},{"description":"Brca1 gene known fam variant","code_information":[{"code":"81215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.49,"maximum":748.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":748.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.01,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene full sequence","code_information":[{"code":"81216","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.86,"maximum":369.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.38,"additional_payer_notes":"APC"}]}]},{"description":"Brca2 gene known fam variant","code_information":[{"code":"81217","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.49,"maximum":748.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":748.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.01,"additional_payer_notes":"APC"}]}]},{"description":"Cebpa gene full sequence","code_information":[{"code":"81218","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":229.80,"maximum":482.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":258.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":229.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":241.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":251.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":482.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":254.0,"additional_payer_notes":"APC"}]}]},{"description":"Calr gene com variants","code_information":[{"code":"81219","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":115.55,"maximum":242.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":126.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":242.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":127.71,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene com variants","code_information":[{"code":"81220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":528.77,"maximum":1110.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":595.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":573.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":556.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":578.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1110.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":590.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":584.43,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene known fam variants","code_information":[{"code":"81221","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":92.36,"maximum":193.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":193.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.08,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene dup/delet variants","code_information":[{"code":"81222","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":413.32,"maximum":867.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":465.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":448.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":413.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":435.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":452.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":483.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":867.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":461.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":456.82,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene full sequence","code_information":[{"code":"81223","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":474.05,"maximum":995.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":533.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":513.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":474.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":499.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":518.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":554.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":995.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":528.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":523.95,"additional_payer_notes":"APC"}]}]},{"description":"Cftr gene intron poly t","code_information":[{"code":"81224","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":160.31,"maximum":336.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":180.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":160.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":187.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":336.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.19,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2c19 gene com variants","code_information":[{"code":"81225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":276.79,"maximum":581.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":311.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":303.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":323.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":581.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":305.93,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2d6 gene com variants","code_information":[{"code":"81226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":428.36,"maximum":899.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":482.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":428.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":450.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":468.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":899.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":477.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":473.46,"additional_payer_notes":"APC"}]}]},{"description":"Cyp2c9 gene com variants","code_information":[{"code":"81227","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Cytogen micrarray copy nmbr","code_information":[{"code":"81228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":855.0,"maximum":1794.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":963.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":927.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":855.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":900.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":936.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1000.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1794.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":954.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":945.0,"additional_payer_notes":"APC"}]}]},{"description":"Cytogen m array copy no&snp","code_information":[{"code":"81229","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1102.0,"maximum":2313.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1102.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1289.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2313.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1218.0,"additional_payer_notes":"APC"}]}]},{"description":"Cyp3a4 gene common variants","code_information":[{"code":"81230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Cyp3a5 gene common variants","code_information":[{"code":"81231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Dpyd gene common variants","code_information":[{"code":"81232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Btk gene common variants","code_information":[{"code":"81233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.63,"maximum":349.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":349.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184.17,"additional_payer_notes":"APC"}]}]},{"description":"Dmpk gene detc abnor allele","code_information":[{"code":"81234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Egfr gene com variants","code_information":[{"code":"81235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.35,"maximum":647.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":347.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":334.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":324.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":337.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":360.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":647.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.81,"additional_payer_notes":"APC"}]}]},{"description":"Ezh2 gene full gene sequence","code_information":[{"code":"81236","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Ezh2 gene common variants","code_information":[{"code":"81237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.63,"maximum":349.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":349.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184.17,"additional_payer_notes":"APC"}]}]},{"description":"F9 full gene sequence","code_information":[{"code":"81238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.0,"maximum":1196.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":667.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1196.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.0,"additional_payer_notes":"APC"}]}]},{"description":"Dmpk gene charac alleles","code_information":[{"code":"81239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"F2 gene","code_information":[{"code":"81240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.41,"maximum":131.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":131.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.97,"additional_payer_notes":"APC"}]}]},{"description":"F5 gene","code_information":[{"code":"81241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.70,"maximum":146.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":146.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77.04,"additional_payer_notes":"APC"}]}]},{"description":"Fancc gene","code_information":[{"code":"81242","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.79,"maximum":73.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":73.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.45,"additional_payer_notes":"APC"}]}]},{"description":"Fmr1 gene detection","code_information":[{"code":"81243","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.19,"maximum":113.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":113.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.46,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.89,"additional_payer_notes":"APC"}]}]},{"description":"Fmr1 gene characterization","code_information":[{"code":"81244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.65,"maximum":89.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":89.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.13,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene","code_information":[{"code":"81245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":157.23,"maximum":330.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":177.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":170.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":157.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":184.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":330.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":173.79,"additional_payer_notes":"APC"}]}]},{"description":"Flt3 gene analysis","code_information":[{"code":"81246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.85,"maximum":165.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.85,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":165.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87.15,"additional_payer_notes":"APC"}]}]},{"description":"G6pd gene alys cmn variant","code_information":[{"code":"81247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"G6pd known familial variant","code_information":[{"code":"81248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.49,"maximum":748.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":748.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.01,"additional_payer_notes":"APC"}]}]},{"description":"G6pd full gene sequence","code_information":[{"code":"81249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.0,"maximum":1196.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":667.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1196.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.0,"additional_payer_notes":"APC"}]}]},{"description":"G6pc gene","code_information":[{"code":"81250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.57,"maximum":116.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":116.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.41,"additional_payer_notes":"APC"}]}]},{"description":"Gba gene","code_information":[{"code":"81251","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.89,"maximum":94.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":94.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.61,"additional_payer_notes":"APC"}]}]},{"description":"Gjb2 gene full sequence","code_information":[{"code":"81252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.06,"maximum":201.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":201.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":107.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106.18,"additional_payer_notes":"APC"}]}]},{"description":"Gjb2 gene known fam variants","code_information":[{"code":"81253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.44,"maximum":122.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.6,"additional_payer_notes":"APC"}]}]},{"description":"Gjb6 gene com variants","code_information":[{"code":"81254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.25,"maximum":69.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.75,"additional_payer_notes":"APC"}]}]},{"description":"Hexa gene","code_information":[{"code":"81255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.88,"maximum":102.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.02,"additional_payer_notes":"APC"}]}]},{"description":"Hfe gene","code_information":[{"code":"81256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.09,"maximum":130.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":130.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.63,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene","code_information":[{"code":"81257","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":97.15,"maximum":203.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":109.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":203.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107.37,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene fam vrnt","code_information":[{"code":"81258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.49,"maximum":748.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":748.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.01,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 full gene sequence","code_information":[{"code":"81259","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.0,"maximum":1196.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":667.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1196.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.0,"additional_payer_notes":"APC"}]}]},{"description":"Ikbkap gene","code_information":[{"code":"81260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.34,"maximum":78.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"}]}]},{"description":"Igh gene rearrange amp meth","code_information":[{"code":"81261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.09,"maximum":394.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":220.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":394.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":207.89,"additional_payer_notes":"APC"}]}]},{"description":"Igh gene rearrang dir probe","code_information":[{"code":"81262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.12,"maximum":136.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":136.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":71.98,"additional_payer_notes":"APC"}]}]},{"description":"Igh vari regional mutation","code_information":[{"code":"81263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":279.79,"maximum":587.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":315.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":303.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":279.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":306.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":327.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":587.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":312.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":309.25,"additional_payer_notes":"APC"}]}]},{"description":"Igk rearrangeabn clonal pop","code_information":[{"code":"81264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.09,"maximum":344.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":172.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":179.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":344.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":181.37,"additional_payer_notes":"APC"}]}]},{"description":"Str markers specimen anal","code_information":[{"code":"81265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":221.42,"maximum":464.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":240.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":259.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":464.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":244.72,"additional_payer_notes":"APC"}]}]},{"description":"Str markers spec anal addl","code_information":[{"code":"81266","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":289.57,"maximum":607.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":326.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":304.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":317.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":338.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":607.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":323.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":320.05,"additional_payer_notes":"APC"}]}]},{"description":"Chimerism anal no cell selec","code_information":[{"code":"81267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":197.09,"maximum":413.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":230.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":413.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.83,"additional_payer_notes":"APC"}]}]},{"description":"Chimerism anal w/cell select","code_information":[{"code":"81268","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.75,"maximum":520.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":279.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":271.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":290.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":520.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.83,"additional_payer_notes":"APC"}]}]},{"description":"Hba1/hba2 gene dup/del vrnts","code_information":[{"code":"81269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.28,"maximum":403.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":403.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212.52,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene","code_information":[{"code":"81270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.08,"maximum":182.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":182.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.24,"additional_payer_notes":"APC"}]}]},{"description":"Htt gene detc abnor alleles","code_information":[{"code":"81271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Kit gene targeted seq analys","code_information":[{"code":"81272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.03,"maximum":657.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":366.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":657.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":349.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.99,"additional_payer_notes":"APC"}]}]},{"description":"Kit gene analys d816 variant","code_information":[{"code":"81273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.63,"maximum":249.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":124.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":249.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.11,"additional_payer_notes":"APC"}]}]},{"description":"Htt gene charac alleles","code_information":[{"code":"81274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Kras gene variants exon 2","code_information":[{"code":"81275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.59,"maximum":385.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":385.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.91,"additional_payer_notes":"APC"}]}]},{"description":"Kras gene addl variants","code_information":[{"code":"81276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.59,"maximum":385.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":385.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.91,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenomic neo microra alys","code_information":[{"code":"81277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1102.0,"maximum":2313.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1241.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1194.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1102.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1160.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1206.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1289.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2313.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1229.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1218.0,"additional_payer_notes":"APC"}]}]},{"description":"Igh@/bcl2 translocation alys","code_information":[{"code":"81278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.94,"maximum":413.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":230.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":413.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.68,"additional_payer_notes":"APC"}]}]},{"description":"Jak2 gene trgt sequence alys","code_information":[{"code":"81279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Ifnl3 gene","code_information":[{"code":"81283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":69.70,"maximum":146.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":146.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77.04,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene detc abnor alleles","code_information":[{"code":"81284","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene charac alleles","code_information":[{"code":"81285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene full gene sequence","code_information":[{"code":"81286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Mgmt gene methylation anal","code_information":[{"code":"81287","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":118.41,"maximum":248.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":124.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":248.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.87,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene","code_information":[{"code":"81288","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.70,"maximum":383.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.09,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":383.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201.94,"additional_payer_notes":"APC"}]}]},{"description":"Fxn gene known famil variant","code_information":[{"code":"81289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Mcoln1 gene","code_information":[{"code":"81290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.34,"maximum":78.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"}]}]},{"description":"Mthfr gene","code_information":[{"code":"81291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.07,"maximum":130.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":130.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.61,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene full seq","code_information":[{"code":"81292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.63,"maximum":1346.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":722.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":695.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":675.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":702.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":751.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1346.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":715.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":709.17,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene known variants","code_information":[{"code":"81293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":314.45,"maximum":660.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":354.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":340.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":331.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":368.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":660.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":350.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":347.55,"additional_payer_notes":"APC"}]}]},{"description":"Mlh1 gene dup/delete variant","code_information":[{"code":"81294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.28,"maximum":403.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":403.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212.52,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene full seq","code_information":[{"code":"81295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":362.62,"maximum":761.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":408.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":393.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":362.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":381.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":396.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":424.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":761.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":404.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":400.78,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene known variants","code_information":[{"code":"81296","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":320.84,"maximum":673.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":361.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":347.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":320.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":337.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":351.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":673.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":357.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":354.62,"additional_payer_notes":"APC"}]}]},{"description":"Msh2 gene dup/delete variant","code_information":[{"code":"81297","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":202.64,"maximum":425.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":202.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":237.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":425.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":223.97,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene full seq","code_information":[{"code":"81298","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.76,"maximum":1280.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":686.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":661.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":609.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":667.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":713.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1280.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":680.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.94,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene known variants","code_information":[{"code":"81299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":292.6,"maximum":614.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":329.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":317.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":292.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":320.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":614.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":326.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.4,"additional_payer_notes":"APC"}]}]},{"description":"Msh6 gene dup/delete variant","code_information":[{"code":"81300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":226.1,"maximum":474.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":254.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":245.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":238.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":474.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":252.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":249.9,"additional_payer_notes":"APC"}]}]},{"description":"Microsatellite instability","code_information":[{"code":"81301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":331.13,"maximum":695.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":372.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":359.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":331.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":348.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":362.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":387.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":695.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":369.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":365.99,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene full seq","code_information":[{"code":"81302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":501.48,"maximum":1052.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":564.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.71,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":501.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":527.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":548.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":586.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1052.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":559.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":554.26,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene known variant","code_information":[{"code":"81303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":114.0,"maximum":239.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":120.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":124.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":239.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":126.0,"additional_payer_notes":"APC"}]}]},{"description":"Mecp2 gene dup/delet variant","code_information":[{"code":"81304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.5,"maximum":299.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":299.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157.5,"additional_payer_notes":"APC"}]}]},{"description":"Myd88 gene p.leu265pro vrnt","code_information":[{"code":"81305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.63,"maximum":349.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":349.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184.17,"additional_payer_notes":"APC"}]}]},{"description":"Nudt15 gene common variants","code_information":[{"code":"81306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":276.79,"maximum":581.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":311.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":303.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":323.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":581.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":305.93,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 gene full gene seq","code_information":[{"code":"81307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":642.68,"maximum":1349.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":723.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":642.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":703.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":752.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1349.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":717.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":710.32,"additional_payer_notes":"APC"}]}]},{"description":"Palb2 gene known famil vrnt","code_information":[{"code":"81308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":286.28,"maximum":600.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":600.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.42,"additional_payer_notes":"APC"}]}]},{"description":"Pik3ca gene trgt seq alys","code_information":[{"code":"81309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Npm1 gene","code_information":[{"code":"81310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.19,"maximum":491.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":253.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":491.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":258.85,"additional_payer_notes":"APC"}]}]},{"description":"Nras gene variants exon 2&3","code_information":[{"code":"81311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":281.00,"maximum":589.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":304.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":281.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":295.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":307.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":328.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":589.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":310.58,"additional_payer_notes":"APC"}]}]},{"description":"Pabpn1 gene detc abnor allel","code_information":[{"code":"81312","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Pca3/klk3 antigen","code_information":[{"code":"81313","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":242.30,"maximum":508.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":255.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":508.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":267.8,"additional_payer_notes":"APC"}]}]},{"description":"Pdgfra gene","code_information":[{"code":"81314","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.03,"maximum":657.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":366.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":657.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":349.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.99,"additional_payer_notes":"APC"}]}]},{"description":"Pml/raralpha com breakpoints","code_information":[{"code":"81315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.94,"maximum":413.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":230.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":413.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.68,"additional_payer_notes":"APC"}]}]},{"description":"Pml/raralpha 1 breakpoint","code_information":[{"code":"81316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":196.94,"maximum":413.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":221.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":230.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":413.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":219.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.68,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 gene full seq analysis","code_information":[{"code":"81317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":642.68,"maximum":1349.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":723.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":696.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":642.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":676.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":703.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":752.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1349.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":717.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":710.32,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 known familial variants","code_information":[{"code":"81318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":314.45,"maximum":660.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":354.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":340.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":331.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":368.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":660.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":350.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":347.55,"additional_payer_notes":"APC"}]}]},{"description":"Pms2 gene dup/delet variants","code_information":[{"code":"81319","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":193.32,"maximum":405.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":217.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":405.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":213.68,"additional_payer_notes":"APC"}]}]},{"description":"Plcg2 gene common variants","code_information":[{"code":"81320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":276.79,"maximum":581.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":311.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":303.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":323.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":581.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":305.93,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene full sequence","code_information":[{"code":"81321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":570.0,"maximum":1196.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":642.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":618.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":570.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":624.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":667.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1196.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":636.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":630.0,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene known fam variant","code_information":[{"code":"81322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.27,"maximum":92.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.93,"additional_payer_notes":"APC"}]}]},{"description":"Pten gene dup/delet variant","code_information":[{"code":"81323","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":285.0,"maximum":598.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":321.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":300.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":312.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":598.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":318.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":315.0,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene dup/delet","code_information":[{"code":"81324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":720.44,"maximum":1512.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":811.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":758.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":788.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":843.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1512.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":803.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":796.28,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene full sequence","code_information":[{"code":"81325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":731.10,"maximum":1534.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":823.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":792.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":731.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":769.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":800.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":855.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1534.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":815.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":808.06,"additional_payer_notes":"APC"}]}]},{"description":"Pmp22 gene known fam variant","code_information":[{"code":"81326","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.27,"maximum":92.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.93,"additional_payer_notes":"APC"}]}]},{"description":"Sept9 methylation analysis","code_information":[{"code":"81327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":182.4,"maximum":382.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":205.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":382.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":203.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201.6,"additional_payer_notes":"APC"}]}]},{"description":"Slco1b1 gene com variants","code_information":[{"code":"81328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gene dos/deletion alys","code_information":[{"code":"81329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Smpd1 gene common variants","code_information":[{"code":"81330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.65,"maximum":93.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":93.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.35,"additional_payer_notes":"APC"}]}]},{"description":"Snrpn/ube3a gene","code_information":[{"code":"81331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.52,"maximum":101.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":101.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.62,"additional_payer_notes":"APC"}]}]},{"description":"Serpina1 gene","code_information":[{"code":"81332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.47,"maximum":87.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.83,"additional_payer_notes":"APC"}]}]},{"description":"Tgfbi gene common variants","code_information":[{"code":"81333","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Runx1 gene targeted seq alys","code_information":[{"code":"81334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.03,"maximum":657.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":366.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":657.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":349.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.99,"additional_payer_notes":"APC"}]}]},{"description":"Tpmt gene com variants","code_information":[{"code":"81335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gene full gene sequence","code_information":[{"code":"81336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":286.28,"maximum":600.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":600.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.42,"additional_payer_notes":"APC"}]}]},{"description":"Smn1 gen nown famil seq vrnt","code_information":[{"code":"81337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Mpl gene common variants","code_information":[{"code":"81338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.81,"maximum":299.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":299.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157.85,"additional_payer_notes":"APC"}]}]},{"description":"Mpl gene seq alys exon 10","code_information":[{"code":"81339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Trb@ gene rearrange amplify","code_information":[{"code":"81340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":198.47,"maximum":416.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":223.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":215.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":217.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":232.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":416.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.46,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":219.37,"additional_payer_notes":"APC"}]}]},{"description":"Trb@ gene rearrange dirprobe","code_information":[{"code":"81341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":47.11,"maximum":98.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":98.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.07,"additional_payer_notes":"APC"}]}]},{"description":"Trg gene rearrangement anal","code_information":[{"code":"81342","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":191.42,"maximum":401.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":215.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":191.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":201.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":224.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":401.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":213.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":211.58,"additional_payer_notes":"APC"}]}]},{"description":"Ppp2r2b gen detc abnor allel","code_information":[{"code":"81343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Tbp gene detc abnor alleles","code_information":[{"code":"81344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Tert gene targeted seq alys","code_information":[{"code":"81345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Tyms gene com variants","code_information":[{"code":"81346","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Sf3b1 gene common variants","code_information":[{"code":"81347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.59,"maximum":385.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":385.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.91,"additional_payer_notes":"APC"}]}]},{"description":"Srsf2 gene common variants","code_information":[{"code":"81348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.63,"maximum":349.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":349.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":184.17,"additional_payer_notes":"APC"}]}]},{"description":"Cytog alys chrml abnr lw-ps","code_information":[{"code":"81349","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1138.04,"maximum":2389.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1281.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1233.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1138.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1197.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1245.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1332.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2389.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1269.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1257.84,"additional_payer_notes":"APC"}]}]},{"description":"Ugt1a1 gene","code_information":[{"code":"81350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":222.3,"maximum":466.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":250.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":241.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":243.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":466.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":248.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":245.7,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene full gene sequence","code_information":[{"code":"81351","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":609.76,"maximum":1280.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":686.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":661.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":609.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":667.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":713.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1280.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":680.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":673.94,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene trgt sequence alys","code_information":[{"code":"81352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":313.03,"maximum":657.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":366.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":657.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":349.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.99,"additional_payer_notes":"APC"}]}]},{"description":"Tp53 gene known famil vrnt","code_information":[{"code":"81353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":292.6,"maximum":614.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":329.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":317.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":292.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":320.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":614.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":326.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.4,"additional_payer_notes":"APC"}]}]},{"description":"Cytog alys chrml abnor ogm","code_information":[{"code":"81354","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1200.35,"maximum":2519.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1351.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1301.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1200.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1263.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1314.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1405.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2519.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1339.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1326.71,"additional_payer_notes":"APC"}]}]},{"description":"Vkorc1 gene","code_information":[{"code":"81355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.79,"maximum":175.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":175.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92.61,"additional_payer_notes":"APC"}]}]},{"description":"U2af1 gene common variants","code_information":[{"code":"81357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.59,"maximum":385.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":385.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.91,"additional_payer_notes":"APC"}]}]},{"description":"Zrsr2 gene common variants","code_information":[{"code":"81360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":183.59,"maximum":385.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":206.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":385.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.91,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene com variants","code_information":[{"code":"81361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":166.07,"maximum":348.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":187.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":166.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":348.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":183.55,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene known fam variant","code_information":[{"code":"81362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":356.49,"maximum":748.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":401.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":386.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":356.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":375.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":390.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":417.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":748.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":394.01,"additional_payer_notes":"APC"}]}]},{"description":"Hbb gene dup/del variants","code_information":[{"code":"81363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":192.28,"maximum":403.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":216.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":208.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":202.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":225.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":403.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":214.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212.52,"additional_payer_notes":"APC"}]}]},{"description":"Hbb full gene sequence","code_information":[{"code":"81364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":308.35,"maximum":647.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":347.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":334.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":308.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":324.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":337.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":360.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":647.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":344.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":340.81,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii typing lr","code_information":[{"code":"81370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":382.01,"maximum":801.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":430.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":414.18,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":382.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":402.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":418.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":447.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":801.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":426.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":422.23,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii type verify lr","code_information":[{"code":"81371","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":384.29,"maximum":806.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":432.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":384.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":404.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":420.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":449.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":806.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":428.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":424.75,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing complete lr","code_information":[{"code":"81372","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":383.41,"maximum":804.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":431.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":415.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":383.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":403.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":419.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":448.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":804.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":427.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":423.77,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 locus lr","code_information":[{"code":"81373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.06,"maximum":254.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":254.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":133.8,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 antigen lr","code_information":[{"code":"81374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.61,"maximum":148.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":148.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.05,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing ag equiv lr","code_information":[{"code":"81375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":209.70,"maximum":440.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":236.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":227.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":220.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":229.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":245.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":440.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":233.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":231.78,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 locus lr","code_information":[{"code":"81376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":116.11,"maximum":243.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":130.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":243.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":128.33,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii type 1 ag equiv lr","code_information":[{"code":"81377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.00,"maximum":188.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":101.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":188.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":99.48,"additional_payer_notes":"APC"}]}]},{"description":"Hla i & ii typing hr","code_information":[{"code":"81378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":328.29,"maximum":689.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":369.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":328.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":359.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":384.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":689.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":366.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":362.85,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing complete hr","code_information":[{"code":"81379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":318.61,"maximum":668.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":358.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":345.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":318.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":348.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":372.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":668.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":352.15,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 locus hr","code_information":[{"code":"81380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.39,"maximum":353.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":189.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.39,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":184.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":353.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":187.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.11,"additional_payer_notes":"APC"}]}]},{"description":"Hla i typing 1 allele hr","code_information":[{"code":"81381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":161.40,"maximum":338.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":181.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":169.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":176.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":338.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":178.4,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 loc hr","code_information":[{"code":"81382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.50,"maximum":246.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":132.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":246.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":131.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.86,"additional_payer_notes":"APC"}]}]},{"description":"Hla ii typing 1 allele hr","code_information":[{"code":"81383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":103.67,"maximum":217.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":217.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.59,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 1","code_information":[{"code":"81400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.76,"maximum":127.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":127.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.16,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 2","code_information":[{"code":"81401","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":130.15,"maximum":273.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":146.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":273.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":143.85,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 3","code_information":[{"code":"81402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.81,"maximum":299.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":299.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157.85,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 4","code_information":[{"code":"81403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":175.94,"maximum":369.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":190.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":175.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":185.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":205.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":369.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":194.46,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 5","code_information":[{"code":"81404","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":261.09,"maximum":548.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":294.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":283.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":285.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":305.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":548.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":288.57,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 6","code_information":[{"code":"81405","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":286.28,"maximum":600.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":322.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":310.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":301.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":313.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":600.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":319.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":316.42,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 7","code_information":[{"code":"81406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":268.74,"maximum":564.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":302.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":291.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":282.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":564.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":299.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":297.02,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 8","code_information":[{"code":"81407","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":803.96,"maximum":1687.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":905.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":803.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":846.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":880.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":941.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1687.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":888.58,"additional_payer_notes":"APC"}]}]},{"description":"Mopath procedure level 9","code_information":[{"code":"81408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1900.0,"maximum":3988.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2140.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2060.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1900.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2000.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2080.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2224.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3988.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2120.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2100.0,"additional_payer_notes":"APC"}]}]},{"description":"Aortic dysfunction/dilation","code_information":[{"code":"81410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":478.8,"maximum":1005.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":539.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":519.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":478.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":504.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":524.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":560.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1005.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":534.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":529.2,"additional_payer_notes":"APC"}]}]},{"description":"Aortic dysfunction/dilation","code_information":[{"code":"81411","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1282.68,"maximum":2692.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1444.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1390.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1282.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1350.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1404.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1501.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2692.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1431.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1417.7,"additional_payer_notes":"APC"}]}]},{"description":"Ashkenazi jewish assoc dis","code_information":[{"code":"81412","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2326.13,"maximum":4883.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2326.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2722.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4883.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2570.99,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnnlpath inc 10 gns","code_information":[{"code":"81413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.66,"maximum":1166.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":555.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":650.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1166.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.14,"additional_payer_notes":"APC"}]}]},{"description":"Car ion chnnlpath inc 2 gns","code_information":[{"code":"81414","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.66,"maximum":1166.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":555.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":650.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1166.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.14,"additional_payer_notes":"APC"}]}]},{"description":"Exome sequence analysis","code_information":[{"code":"81415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4541.0,"maximum":9532.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5114.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4923.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4541.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4780.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4971.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5315.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9532.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5066.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5019.0,"additional_payer_notes":"APC"}]}]},{"description":"Exome sequence analysis","code_information":[{"code":"81416","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11400.0,"maximum":23931.6,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12840.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12360.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11400.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12000.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12480.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13344.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23931.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12720.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12600.0,"additional_payer_notes":"APC"}]}]},{"description":"Exome re-evaluation","code_information":[{"code":"81417","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":304.0,"maximum":638.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":342.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":329.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":304.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":320.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":355.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":638.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":336.0,"additional_payer_notes":"APC"}]}]},{"description":"Rx metab gen seq alys pnl 6","code_information":[{"code":"81418","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":871.23,"maximum":1828.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":981.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":944.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":871.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":917.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":953.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1019.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1828.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":972.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":962.93,"additional_payer_notes":"APC"}]}]},{"description":"Epilepsy gen seq alys panel","code_information":[{"code":"81419","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2326.13,"maximum":4883.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2326.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2722.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4883.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2570.99,"additional_payer_notes":"APC"}]}]},{"description":"Fetal chrmoml aneuploidy","code_information":[{"code":"81420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Fetal chrmoml microdeltj","code_information":[{"code":"81422","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.10,"maximum":1513.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":781.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1513.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":804.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.0,"additional_payer_notes":"APC"}]}]},{"description":"Genome sequence analysis","code_information":[{"code":"81425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4779.64,"maximum":10033.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5383.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5182.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4779.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5031.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5232.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5594.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10033.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5333.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5282.76,"additional_payer_notes":"APC"}]}]},{"description":"Genome sequence analysis","code_information":[{"code":"81426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2574.45,"maximum":5404.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2899.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2791.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2574.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2709.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2818.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3013.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5404.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2872.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2845.45,"additional_payer_notes":"APC"}]}]},{"description":"Genome re-evaluation","code_information":[{"code":"81427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2220.77,"maximum":4661.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2501.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2407.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2220.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2337.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2431.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2599.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4661.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2477.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2454.53,"additional_payer_notes":"APC"}]}]},{"description":"Hearing loss sequence analys","code_information":[{"code":"81430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1543.75,"maximum":3240.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1738.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1673.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1543.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1625.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1690.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1807.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":3240.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1722.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1706.25,"additional_payer_notes":"APC"}]}]},{"description":"Hearing loss dup/del analys","code_information":[{"code":"81431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":645.59,"maximum":1355.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":699.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":645.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":679.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":755.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1355.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.55,"additional_payer_notes":"APC"}]}]},{"description":"Hrdtry brst ca-rlatd dsordrs","code_information":[{"code":"81432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.75,"maximum":2600.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1238.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1449.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2600.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1369.15,"additional_payer_notes":"APC"}]}]},{"description":"Hereditary retinal disorders","code_information":[{"code":"81434","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.01,"maximum":1192.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":568.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":664.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1192.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":627.81,"additional_payer_notes":"APC"}]}]},{"description":"Hereditary colon ca dsordrs","code_information":[{"code":"81435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.75,"maximum":2600.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1238.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1449.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2600.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1369.15,"additional_payer_notes":"APC"}]}]},{"description":"Heredtry nurondcrn tum dsrdr","code_information":[{"code":"81437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1238.75,"maximum":2600.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1395.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1343.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1238.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1303.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1356.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1449.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2600.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1382.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1369.15,"additional_payer_notes":"APC"}]}]},{"description":"Inherited cardmypthy 5 gns","code_information":[{"code":"81439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.66,"maximum":1166.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":555.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":650.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1166.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.14,"additional_payer_notes":"APC"}]}]},{"description":"Mitochondrial gene","code_information":[{"code":"81440","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3157.8,"maximum":6629.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3556.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3423.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3157.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3324.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3456.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3696.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6629.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3523.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3490.2,"additional_payer_notes":"APC"}]}]},{"description":"Ibmfs seq alys pnl 30 genes","code_information":[{"code":"81441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2326.13,"maximum":4883.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2326.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2722.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4883.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2570.99,"additional_payer_notes":"APC"}]}]},{"description":"Noonan spectrum disorders","code_information":[{"code":"81442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2036.42,"maximum":4274.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2293.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2207.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2036.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2143.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2229.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2383.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4274.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2272.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2250.78,"additional_payer_notes":"APC"}]}]},{"description":"Genetic tstg severe inh cond","code_information":[{"code":"81443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2326.13,"maximum":4883.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2619.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2522.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2326.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2448.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2546.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2722.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4883.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2595.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2570.99,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.01,"maximum":1192.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":568.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":664.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1192.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":627.81,"additional_payer_notes":"APC"}]}]},{"description":"Hrdtry perph neurphy panel","code_information":[{"code":"81448","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":555.66,"maximum":1166.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":625.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":555.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":584.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":650.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1166.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":619.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":614.14,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so neo 5-50 rna alys","code_information":[{"code":"81449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":568.01,"maximum":1192.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":639.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":615.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":568.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":597.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":621.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":664.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1192.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":633.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":627.81,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.55,"maximum":1514.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1514.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.51,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap hl neo 5-50 rna alys","code_information":[{"code":"81451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":721.55,"maximum":1514.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":812.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":721.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":759.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":789.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":844.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1514.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":797.51,"additional_payer_notes":"APC"}]}]},{"description":"Targeted genomic seq analys","code_information":[{"code":"81455","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"Tgsap so/hl 51/< rna alys","code_information":[{"code":"81456","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2773.62,"maximum":5822.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3123.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3007.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2773.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2919.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3036.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3246.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5822.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3094.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3065.58,"additional_payer_notes":"APC"}]}]},{"description":"So neo gsap dna mcrstl ins","code_information":[{"code":"81457","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":852.03,"maximum":1788.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":852.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":896.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.71,"additional_payer_notes":"APC"}]}]},{"description":"So gsap dna cpy nmbr&mcrstl","code_information":[{"code":"81458","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":994.03,"maximum":2086.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1119.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1077.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":994.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1046.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1088.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1163.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2086.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1109.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1098.67,"additional_payer_notes":"APC"}]}]},{"description":"So neo gsap dna/dna&rna","code_information":[{"code":"81459","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2840.07,"maximum":5962.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3198.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3079.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2840.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2989.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3109.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3324.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5962.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3168.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3139.03,"additional_payer_notes":"APC"}]}]},{"description":"Whole mitochondrial genome","code_information":[{"code":"81460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1222.65,"maximum":2566.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1377.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1325.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1222.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1287.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1338.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1431.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2566.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1364.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1351.35,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cll fr dna/dna&rna","code_information":[{"code":"81462","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1136.04,"maximum":2384.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1279.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1231.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1136.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1195.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1243.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1329.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2384.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1267.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1255.62,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cl fr cpy nmbr&mcrst","code_information":[{"code":"81463","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1278.04,"maximum":2682.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1439.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1385.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1278.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1345.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1399.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1495.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2682.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1426.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1412.58,"additional_payer_notes":"APC"}]}]},{"description":"So gsap cll fr mcrstl ins","code_information":[{"code":"81464","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3124.08,"maximum":6558.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3518.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3387.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3124.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3288.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3656.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6558.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3485.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3452.94,"additional_payer_notes":"APC"}]}]},{"description":"Whole mitochondrial genome","code_information":[{"code":"81465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":889.2,"maximum":1866.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1001.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":964.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":889.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":936.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":973.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1040.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1866.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":992.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":982.8,"additional_payer_notes":"APC"}]}]},{"description":"X-linked intellectual dblt","code_information":[{"code":"81470","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":868.3,"maximum":1822.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":977.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":941.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":868.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":914.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1016.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1822.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":968.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.7,"additional_payer_notes":"APC"}]}]},{"description":"X-linked intellectual dblt","code_information":[{"code":"81471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":868.3,"maximum":1822.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":977.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":941.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":868.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":914.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1016.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1822.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":968.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.7,"additional_payer_notes":"APC"}]}]},{"description":"Autoimmune rheumatoid arthr","code_information":[{"code":"81490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":798.62,"maximum":1676.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":899.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":865.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":798.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":840.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":874.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":934.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1676.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":891.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":882.68,"additional_payer_notes":"APC"}]}]},{"description":"Cor artery disease mrna","code_information":[{"code":"81493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":997.5,"maximum":2094.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1123.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1081.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1050.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1092.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1167.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2094.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1113.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1102.5,"additional_payer_notes":"APC"}]}]},{"description":"Onco (ovar) two proteins","code_information":[{"code":"81500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":247.48,"maximum":519.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":278.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":268.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":289.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":519.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":276.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":273.53,"additional_payer_notes":"APC"}]}]},{"description":"Onco (ovar) five proteins","code_information":[{"code":"81503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":852.15,"maximum":1788.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":959.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":923.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":852.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":897.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":932.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":997.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1788.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":950.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":941.85,"additional_payer_notes":"APC"}]}]},{"description":"Oncology tissue of origin","code_information":[{"code":"81504","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":494.0,"maximum":1037.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":556.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":535.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":494.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":520.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":540.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":578.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1037.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":551.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":546.0,"additional_payer_notes":"APC"}]}]},{"description":"Endo assay seven anal","code_information":[{"code":"81506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.47,"maximum":137.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":137.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72.37,"additional_payer_notes":"APC"}]}]},{"description":"Fetal aneuploidy trisom risk","code_information":[{"code":"81507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":755.25,"maximum":1585.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":850.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":818.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":755.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":795.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":826.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":884.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1585.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":842.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":834.75,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor two proteins","code_information":[{"code":"81508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":51.58,"maximum":108.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":108.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.02,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor 3 proteins","code_information":[{"code":"81509","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1413.00,"maximum":2966.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1591.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1531.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1413.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1487.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1546.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1653.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":2966.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1576.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":1561.74,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor three anal","code_information":[{"code":"81510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.76,"maximum":110.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":110.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.32,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor four anal","code_information":[{"code":"81511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":145.82,"maximum":306.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":145.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":153.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":170.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":306.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":161.18,"additional_payer_notes":"APC"}]}]},{"description":"Ftl cgen abnor five anal","code_information":[{"code":"81512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.04,"maximum":138.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":138.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.0,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv rna vag flu alg","code_information":[{"code":"81513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv&vaginitis dna alg","code_information":[{"code":"81514","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.84,"maximum":524.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":292.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":524.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":276.14,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds bv&vaginitis dna alg","code_information":[{"code":"81515","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.84,"maximum":524.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":292.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":524.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":276.14,"additional_payer_notes":"APC"}]}]},{"description":"Liver ds alys 3 bmrk srm alg","code_information":[{"code":"81517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":167.38,"maximum":351.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":188.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":181.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":176.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":351.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":186.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":185.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst mrna 11 genes","code_information":[{"code":"81518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Oncology breast mrna","code_information":[{"code":"81519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 58 genes","code_information":[{"code":"81520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2384.70,"maximum":5006.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2685.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2585.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2384.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2510.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2610.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2791.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5006.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2660.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2635.72,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 70 genes","code_information":[{"code":"81521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc breast mrna 12 genes","code_information":[{"code":"81522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc brst mrna 70 cnt 31 gene","code_information":[{"code":"81523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Oncology colon mrna","code_information":[{"code":"81525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2960.2,"maximum":6214.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3334.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3209.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2960.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3116.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3464.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6214.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3302.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3271.8,"additional_payer_notes":"APC"}]}]},{"description":"Oncology colorectal scr","code_information":[{"code":"81528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":483.43,"maximum":1014.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":544.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":524.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":483.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":508.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":529.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":565.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1014.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":539.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":534.31,"additional_payer_notes":"APC"}]}]},{"description":"Onc cutan mlnma mrna 31 gene","code_information":[{"code":"81529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6833.35,"maximum":14345.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7696.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7408.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6833.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7193.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7480.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7998.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14345.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7624.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7552.65,"additional_payer_notes":"APC"}]}]},{"description":"Oncology gynecologic","code_information":[{"code":"81535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":550.49,"maximum":1155.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":620.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":596.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":550.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":579.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":602.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":644.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1155.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":614.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":608.43,"additional_payer_notes":"APC"}]}]},{"description":"Oncology gynecologic","code_information":[{"code":"81536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":168.68,"maximum":354.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":189.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":182.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":168.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":177.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":184.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":354.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":186.44,"additional_payer_notes":"APC"}]}]},{"description":"Oncology lung","code_information":[{"code":"81538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2727.45,"maximum":5725.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3071.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2957.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2727.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2871.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2985.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3192.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5725.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3043.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3014.55,"additional_payer_notes":"APC"}]}]},{"description":"Oncology prostate prob score","code_information":[{"code":"81539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":722.0,"maximum":1515.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":813.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":782.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":760.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":790.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":845.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1515.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":805.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":798.0,"additional_payer_notes":"APC"}]}]},{"description":"Oncology tum unknown origin","code_information":[{"code":"81540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3562.5,"maximum":7478.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4012.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3862.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3562.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3750.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3900.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4170.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7478.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3975.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3937.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate mrna 46 genes","code_information":[{"code":"81541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate mrna 22 cnt gen","code_information":[{"code":"81542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3679.35,"maximum":7723.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4144.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3989.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3679.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3873.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4027.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4306.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7723.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4105.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4066.65,"additional_payer_notes":"APC"}]}]},{"description":"Onc thyr mrna 10,196 gen alg","code_information":[{"code":"81546","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3420.0,"maximum":7179.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3852.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3708.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3420.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3600.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3744.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4003.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7179.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3816.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3780.0,"additional_payer_notes":"APC"}]}]},{"description":"Onc prostate 3 genes","code_information":[{"code":"81551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":1928.5,"maximum":4048.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2172.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2090.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":1928.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2030.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2111.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2257.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4048.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2151.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2131.5,"additional_payer_notes":"APC"}]}]},{"description":"Onc uveal mlnma mrna 15 gene","code_information":[{"code":"81552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7387.2,"maximum":15507.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8320.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8009.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7387.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7776.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8087.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8646.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15507.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8242.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8164.8,"additional_payer_notes":"APC"}]}]},{"description":"Pulm ds ipf mrna 190 gen alg","code_information":[{"code":"81554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5139.12,"maximum":10788.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5788.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5571.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5139.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5409.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5625.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6015.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10788.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5734.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5680.08,"additional_payer_notes":"APC"}]}]},{"description":"Trnspl rej kdn mrna qpcr 139","code_information":[{"code":"81558","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3078.0,"maximum":6461.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3466.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3078.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3602.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6461.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3434.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.0,"additional_payer_notes":"APC"}]}]},{"description":"Trnsplj pd lvr&bwl cd154+cll","code_information":[{"code":"81560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":608.69,"maximum":1277.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":685.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":659.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":608.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":640.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":666.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":712.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1277.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":679.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":672.77,"additional_payer_notes":"APC"}]}]},{"description":"Cardiology hrt trnspl mrna","code_information":[{"code":"81595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3078.0,"maximum":6461.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3466.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3337.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3078.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3240.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3369.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3602.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6461.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3434.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3402.0,"additional_payer_notes":"APC"}]}]},{"description":"Nfct ds chrnc hcv 6 assays","code_information":[{"code":"81596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.58,"maximum":143.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":143.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.8,"additional_payer_notes":"APC"}]}]},{"description":"Test for acetone/ketones","code_information":[{"code":"82009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.29,"maximum":9.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"}]}]},{"description":"Acetone assay","code_information":[{"code":"82010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.76,"maximum":16.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholinesterase assay","code_information":[{"code":"82013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.68,"maximum":24.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"}]}]},{"description":"Acylcarnitines qual","code_information":[{"code":"82016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.67,"maximum":32.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"APC"}]}]},{"description":"Acylcarnitines quant","code_information":[{"code":"82017","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.03,"maximum":33.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"}]}]},{"description":"Assay of acth","code_information":[{"code":"82024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.69,"maximum":77.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":77.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay of adp & amp","code_information":[{"code":"82030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.51,"maximum":51.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum albumin","code_information":[{"code":"82040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.70,"maximum":9.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine albumin","code_information":[{"code":"82042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.39,"maximum":15.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.39,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"}]}]},{"description":"Microalbumin quantitative","code_information":[{"code":"82043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.49,"maximum":11.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.07,"additional_payer_notes":"APC"}]}]},{"description":"Microalbumin semiquant","code_information":[{"code":"82044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.92,"maximum":12.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"}]}]},{"description":"Albumin ischemia modified","code_information":[{"code":"82045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.24,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of breath ethanol","code_information":[{"code":"82075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.5,"maximum":59.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.5,"additional_payer_notes":"APC"}]}]},{"description":"Assay spec xcp ur&breath ia","code_information":[{"code":"82077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aldolase","code_information":[{"code":"82085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.22,"maximum":19.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aldosterone","code_information":[{"code":"82088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.71,"maximum":81.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":81.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.79,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-1-antitrypsin total","code_information":[{"code":"82103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.77,"maximum":26.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-1-antitrypsin pheno","code_information":[{"code":"82104","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.74,"maximum":28.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-fetoprotein serum","code_information":[{"code":"82105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.93,"maximum":33.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-fetoprotein amniotic","code_information":[{"code":"82106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.15,"maximum":33.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.85,"additional_payer_notes":"APC"}]}]},{"description":"Alpha-Fetoprotein L3","code_information":[{"code":"82107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.19,"maximum":128.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay of aluminum","code_information":[{"code":"82108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.21,"maximum":50.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.75,"additional_payer_notes":"APC"}]}]},{"description":"Amines vaginal fluid qual","code_information":[{"code":"82120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.69,"maximum":11.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"}]}]},{"description":"Amino acid single qual","code_information":[{"code":"82127","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.47,"maximum":28.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids mult qual","code_information":[{"code":"82128","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.18,"maximum":27.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids single quant","code_information":[{"code":"82131","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.83,"maximum":45.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay aminolevulinic acid","code_information":[{"code":"82135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.63,"maximum":32.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids quant 2-5","code_information":[{"code":"82136","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.63,"maximum":39.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.59,"additional_payer_notes":"APC"}]}]},{"description":"Amino acids quan 6 or more","code_information":[{"code":"82139","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.03,"maximum":33.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ammonia","code_information":[{"code":"82140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.84,"maximum":29.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"}]}]},{"description":"Amniotic fluid scan","code_information":[{"code":"82143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.88,"maximum":18.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of amylase","code_information":[{"code":"82150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.16,"maximum":12.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.8,"additional_payer_notes":"APC"}]}]},{"description":"Androstanediol glucuronide","code_information":[{"code":"82154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.39,"maximum":57.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.39,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.27,"additional_payer_notes":"APC"}]}]},{"description":"Assay of androstenedione","code_information":[{"code":"82157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.82,"maximum":58.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay of androsterone","code_information":[{"code":"82160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.27,"maximum":50.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay of angiotensin II","code_information":[{"code":"82163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.49,"maximum":40.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.55,"additional_payer_notes":"APC"}]}]},{"description":"Angiotensin I enzyme test","code_information":[{"code":"82164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.87,"maximum":29.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay anti-mullerian horm","code_information":[{"code":"82166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.69,"maximum":77.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":77.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay of apolipoprotein","code_information":[{"code":"82172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.04,"maximum":42.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay of arsenic","code_information":[{"code":"82175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.02,"maximum":37.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ascorbic acid","code_information":[{"code":"82180","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.40,"maximum":19.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"}]}]},{"description":"Atomic absorption","code_information":[{"code":"82190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.10,"maximum":31.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of beta-2 protein","code_information":[{"code":"82232","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.37,"maximum":32.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.99,"additional_payer_notes":"APC"}]}]},{"description":"Beta-amyloid 1-40 (abeta 40)","code_information":[{"code":"82233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.47,"maximum":257.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":257.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.37,"additional_payer_notes":"APC"}]}]},{"description":"Beta-amyloid 1-42 (abeta 42)","code_information":[{"code":"82234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.47,"maximum":257.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":257.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.37,"additional_payer_notes":"APC"}]}]},{"description":"Bile acids total","code_information":[{"code":"82239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.26,"maximum":34.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"}]}]},{"description":"Bile acids cholylglycine","code_information":[{"code":"82240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.25,"maximum":53.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.91,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin total","code_information":[{"code":"82247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.77,"maximum":10.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin direct","code_information":[{"code":"82248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.77,"maximum":10.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"}]}]},{"description":"Fecal bilirubin test","code_information":[{"code":"82252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.33,"maximum":9.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of biotinidase","code_information":[{"code":"82261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.03,"maximum":33.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"}]}]},{"description":"Occult blood feces","code_information":[{"code":"82270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.16,"maximum":8.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"APC"}]}]},{"description":"Occult blood other sources","code_information":[{"code":"82271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.05,"maximum":10.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.59,"additional_payer_notes":"APC"}]}]},{"description":"Occult bld feces 1-3 tests","code_information":[{"code":"82272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.02,"maximum":8.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay test for blood fecal","code_information":[{"code":"82274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.12,"maximum":31.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.72,"additional_payer_notes":"APC"}]}]},{"description":"Assay of bradykinin","code_information":[{"code":"82286","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.90,"maximum":10.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cadmium","code_information":[{"code":"82300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.46,"maximum":47.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.82,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin d 25 hydroxy","code_information":[{"code":"82306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.12,"maximum":59.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.08,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcitonin","code_information":[{"code":"82308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.45,"maximum":53.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium","code_information":[{"code":"82310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.90,"maximum":10.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.42,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium","code_information":[{"code":"82330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.00,"maximum":27.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"}]}]},{"description":"Calcium infusion test","code_information":[{"code":"82331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.67,"maximum":26.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay of calcium in urine","code_information":[{"code":"82340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.73,"maximum":12.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.33,"additional_payer_notes":"APC"}]}]},{"description":"Calculus analysis qual","code_information":[{"code":"82355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.00,"maximum":23.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.16,"additional_payer_notes":"APC"}]}]},{"description":"Calculus assay quant","code_information":[{"code":"82360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.23,"maximum":25.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"}]}]},{"description":"Calculus spectroscopy","code_information":[{"code":"82365","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.26,"maximum":25.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"}]}]},{"description":"X-ray assay calculus","code_information":[{"code":"82370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.89,"maximum":24.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay c-d transfer measure","code_information":[{"code":"82373","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.16,"maximum":36.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay blood carbon dioxide","code_information":[{"code":"82374","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.64,"maximum":9.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay carboxyhb quant","code_information":[{"code":"82375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.70,"maximum":24.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay carboxyhb qual","code_information":[{"code":"82376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.37,"maximum":28.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.77,"additional_payer_notes":"APC"}]}]},{"description":"Carcinoembryonic antigen","code_information":[{"code":"82378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.01,"maximum":37.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of carnitine","code_information":[{"code":"82379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.03,"maximum":33.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"}]}]},{"description":"Assay of carotene","code_information":[{"code":"82380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.76,"maximum":18.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay urine catecholamines","code_information":[{"code":"82382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.94,"maximum":54.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay blood catecholamines","code_information":[{"code":"82383","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.63,"maximum":57.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.53,"additional_payer_notes":"APC"}]}]},{"description":"Assay three catecholamines","code_information":[{"code":"82384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.99,"maximum":50.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.51,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cathepsin-d","code_information":[{"code":"82387","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.16,"maximum":36.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ceruloplasmin","code_information":[{"code":"82390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.20,"maximum":21.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"}]}]},{"description":"Chemiluminescent assay","code_information":[{"code":"82397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.41,"maximum":28.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay of chloramphenicol","code_information":[{"code":"82415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.04,"maximum":25.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood chloride","code_information":[{"code":"82435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.37,"maximum":9.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine chloride","code_information":[{"code":"82436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.46,"maximum":11.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"APC"}]}]},{"description":"Assay other fluid chlorides","code_information":[{"code":"82438","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.75,"maximum":9.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"}]}]},{"description":"Test for chlorohydrocarbons","code_information":[{"code":"82441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.71,"maximum":11.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay bld/serum cholesterol","code_information":[{"code":"82465","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.13,"maximum":8.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay serum cholinesterase","code_information":[{"code":"82480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.48,"maximum":15.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"}]}]},{"description":"Assay rbc cholinesterase","code_information":[{"code":"82482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.32,"maximum":19.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay chondroitin sulfate","code_information":[{"code":"82485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.62,"maximum":41.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"}]}]},{"description":"Assay of chromium","code_information":[{"code":"82495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.27,"maximum":40.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of citrate","code_information":[{"code":"82507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.41,"maximum":55.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.19,"additional_payer_notes":"APC"}]}]},{"description":"Collagen crosslinks","code_information":[{"code":"82523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.75,"maximum":37.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"}]}]},{"description":"Assay of copper","code_information":[{"code":"82525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.79,"maximum":24.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"}]}]},{"description":"Assay of corticosterone","code_information":[{"code":"82528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.39,"maximum":44.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.39,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.65,"additional_payer_notes":"APC"}]}]},{"description":"Cortisol free","code_information":[{"code":"82530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.87,"maximum":33.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"}]}]},{"description":"Total cortisol","code_information":[{"code":"82533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.48,"maximum":32.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of creatine","code_information":[{"code":"82540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.41,"maximum":9.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"}]}]},{"description":"Col chromotography qual/quan","code_information":[{"code":"82542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.89,"maximum":48.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ck (cpk)","code_information":[{"code":"82550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.18,"maximum":12.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cpk in blood","code_information":[{"code":"82552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.72,"maximum":26.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.06,"additional_payer_notes":"APC"}]}]},{"description":"Creatine mb fraction","code_information":[{"code":"82553","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.97,"maximum":23.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.13,"additional_payer_notes":"APC"}]}]},{"description":"Creatine isoforms","code_information":[{"code":"82554","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.28,"maximum":23.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay of creatinine","code_information":[{"code":"82565","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.86,"maximum":10.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.38,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine creatinine","code_information":[{"code":"82570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.92,"maximum":10.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"}]}]},{"description":"Creatinine clearance test","code_information":[{"code":"82575","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.99,"maximum":18.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cryofibrinogen","code_information":[{"code":"82585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.43,"maximum":28.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.85,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cryoglobulin","code_information":[{"code":"82595","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of cyanide","code_information":[{"code":"82600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.43,"maximum":38.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"}]}]},{"description":"Vitamin B-12","code_information":[{"code":"82607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.33,"maximum":30.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.83,"additional_payer_notes":"APC"}]}]},{"description":"B-12 binding capacity","code_information":[{"code":"82608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.60,"maximum":28.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"}]}]},{"description":"Cystatin c","code_information":[{"code":"82610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.59,"maximum":36.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.45,"additional_payer_notes":"APC"}]}]},{"description":"Test for urine cystines","code_information":[{"code":"82615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.07,"maximum":19.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"}]}]},{"description":"Dehydroepiandrosterone","code_information":[{"code":"82626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.01,"maximum":50.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.53,"additional_payer_notes":"APC"}]}]},{"description":"Dehydroepiandrosterone","code_information":[{"code":"82627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.12,"maximum":44.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.34,"additional_payer_notes":"APC"}]}]},{"description":"Desoxycorticosterone","code_information":[{"code":"82633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.43,"maximum":61.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":61.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.53,"additional_payer_notes":"APC"}]}]},{"description":"Deoxycortisol","code_information":[{"code":"82634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.82,"maximum":58.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay of dibucaine number","code_information":[{"code":"82638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.64,"maximum":24.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"APC"}]}]},{"description":"Dihydrotestosterone","code_information":[{"code":"82642","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.82,"maximum":58.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.74,"additional_payer_notes":"APC"}]}]},{"description":"Vit d 1 25-dihydroxy","code_information":[{"code":"82652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.58,"maximum":76.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.43,"additional_payer_notes":"APC"}]}]},{"description":"El-1 fecal quantitative","code_information":[{"code":"82653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.82,"maximum":45.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.12,"additional_payer_notes":"APC"}]}]},{"description":"Pancreatic elastase fecal","code_information":[{"code":"82656","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.95,"maximum":22.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme cell activity","code_information":[{"code":"82657","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.06,"maximum":44.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"APC"}]}]},{"description":"Enzyme cell activity ra","code_information":[{"code":"82658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.83,"maximum":87.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.23,"additional_payer_notes":"APC"}]}]},{"description":"Electrophoretic test","code_information":[{"code":"82664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.42,"maximum":122.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":122.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":64.58,"additional_payer_notes":"APC"}]}]},{"description":"Assay of erythropoietin","code_information":[{"code":"82668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.85,"maximum":37.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.85,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estradiol","code_information":[{"code":"82670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.54,"maximum":55.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogens","code_information":[{"code":"82671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.68,"maximum":64.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogen","code_information":[{"code":"82672","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.62,"maximum":43.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estriol","code_information":[{"code":"82677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.97,"maximum":48.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrone","code_information":[{"code":"82679","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.70,"maximum":49.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay dir meas fr estradiol","code_information":[{"code":"82681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.54,"maximum":55.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ethylene glycol","code_information":[{"code":"82693","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.16,"maximum":29.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"}]}]},{"description":"Assay of etiocholanolone","code_information":[{"code":"82696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.93,"maximum":52.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":52.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.55,"additional_payer_notes":"APC"}]}]},{"description":"Fats/lipids feces qual","code_information":[{"code":"82705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.84,"maximum":10.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.36,"additional_payer_notes":"APC"}]}]},{"description":"Fats/lipids feces quant","code_information":[{"code":"82710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.96,"maximum":33.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fecal fat","code_information":[{"code":"82715","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.82,"maximum":45.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood fatty acids","code_information":[{"code":"82725","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.83,"maximum":37.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.71,"additional_payer_notes":"APC"}]}]},{"description":"Long chain fatty acids","code_information":[{"code":"82726","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.76,"maximum":39.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ferritin","code_information":[{"code":"82728","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.95,"maximum":27.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fetal fibronectin","code_information":[{"code":"82731","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.19,"maximum":128.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay of fluoride","code_information":[{"code":"82735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of folic acid serum","code_information":[{"code":"82746","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.96,"maximum":29.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of folic acid rbc","code_information":[{"code":"82747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.77,"maximum":35.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.53,"additional_payer_notes":"APC"}]}]},{"description":"Assay of semen fructose","code_information":[{"code":"82757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.47,"maximum":34.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.21,"additional_payer_notes":"APC"}]}]},{"description":"Assay of rbc galactokinase","code_information":[{"code":"82759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.41,"maximum":42.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay of galactose","code_information":[{"code":"82760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.64,"maximum":22.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay galactose transferase","code_information":[{"code":"82775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.02,"maximum":42.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"}]}]},{"description":"Galactose transferase test","code_information":[{"code":"82776","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.15,"maximum":23.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"}]}]},{"description":"Galectin-3","code_information":[{"code":"82777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":42.04,"maximum":88.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":88.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.46,"additional_payer_notes":"APC"}]}]},{"description":"Assay iga/igd/igg/igm each","code_information":[{"code":"82784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.84,"maximum":18.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ige","code_information":[{"code":"82785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.64,"maximum":32.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"}]}]},{"description":"Igg 1 2 3 or 4 each","code_information":[{"code":"82787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.62,"maximum":15.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"}]}]},{"description":"Blood pH","code_information":[{"code":"82800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.45,"maximum":21.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases any combination","code_information":[{"code":"82803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.77,"maximum":51.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.37,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases w/o2 saturation","code_information":[{"code":"82805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.83,"maximum":157.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":157.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.71,"additional_payer_notes":"APC"}]}]},{"description":"Blood gases o2 sat only","code_information":[{"code":"82810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.28,"maximum":19.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.26,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin-oxygen affinity","code_information":[{"code":"82820","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.67,"maximum":26.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"}]}]},{"description":"Gastric analy w/ph ea spec","code_information":[{"code":"82930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.37,"maximum":13.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.05,"additional_payer_notes":"APC"}]}]},{"description":"Gastrin test","code_information":[{"code":"82938","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.81,"maximum":35.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gastrin","code_information":[{"code":"82941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.75,"maximum":35.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.51,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glucagon","code_information":[{"code":"82943","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.58,"maximum":28.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"}]}]},{"description":"Glucose Other Fluid","code_information":[{"code":"82945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.73,"maximum":7.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.73,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.13,"additional_payer_notes":"APC"}]}]},{"description":"Glucagon tolerance test","code_information":[{"code":"82946","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.88,"maximum":35.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.66,"additional_payer_notes":"APC"}]}]},{"description":"Assay glucose blood quant","code_information":[{"code":"82947","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.73,"maximum":7.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.73,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.13,"additional_payer_notes":"APC"}]}]},{"description":"Reagent strip/blood glucose","code_information":[{"code":"82948","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.79,"maximum":10.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"APC"}]}]},{"description":"Glucose test","code_information":[{"code":"82950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.51,"maximum":9.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.99,"additional_payer_notes":"APC"}]}]},{"description":"Glucose tolerance test (GTT)","code_information":[{"code":"82951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.23,"maximum":25.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"}]}]},{"description":"GTT-added samples","code_information":[{"code":"82952","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.72,"maximum":7.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of g6pd enzyme","code_information":[{"code":"82955","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.22,"maximum":19.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"}]}]},{"description":"Test for G6PD enzyme","code_information":[{"code":"82960","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.75,"maximum":12.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"}]}]},{"description":"Glucose blood test","code_information":[{"code":"82962","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.12,"maximum":6.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glucosidase","code_information":[{"code":"82963","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.41,"maximum":42.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gdh enzyme","code_information":[{"code":"82965","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.49,"maximum":26.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of GGT","code_information":[{"code":"82977","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.84,"maximum":14.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glutathione","code_information":[{"code":"82978","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.68,"maximum":30.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay rbc glutathione","code_information":[{"code":"82979","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.97,"maximum":18.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of glycated protein","code_information":[{"code":"82985","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.92,"maximum":33.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gonadotropin (fsh)","code_information":[{"code":"83001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.65,"maximum":37.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.51,"additional_payer_notes":"APC"}]}]},{"description":"Assay of gonadotropin (lh)","code_information":[{"code":"83002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.59,"maximum":36.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay growth hormone (hgh)","code_information":[{"code":"83003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.84,"maximum":33.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.5,"additional_payer_notes":"APC"}]}]},{"description":"Growth stimulation gene 2","code_information":[{"code":"83006","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.82,"maximum":150.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":150.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.38,"additional_payer_notes":"APC"}]}]},{"description":"H pylori (c-13) blood","code_information":[{"code":"83009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.99,"maximum":134.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":134.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.73,"additional_payer_notes":"APC"}]}]},{"description":"Assay of haptoglobin quant","code_information":[{"code":"83010","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.95,"maximum":25.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"}]}]},{"description":"Assay of haptoglobins","code_information":[{"code":"83012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.55,"maximum":53.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.23,"additional_payer_notes":"APC"}]}]},{"description":"H pylori (c-13) breath","code_information":[{"code":"83013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":63.99,"maximum":134.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":134.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.73,"additional_payer_notes":"APC"}]}]},{"description":"H pylori drug admin","code_information":[{"code":"83014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.47,"maximum":15.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"}]}]},{"description":"Heavy metal qual any anal","code_information":[{"code":"83015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.89,"maximum":41.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"}]}]},{"description":"Heavy metal quant each nes","code_information":[{"code":"83018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.86,"maximum":43.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.06,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin electrophoresis","code_information":[{"code":"83020","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.23,"maximum":25.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin chromotography","code_information":[{"code":"83021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.16,"maximum":36.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin copper sulfate","code_information":[{"code":"83026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.81,"maximum":8.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.21,"additional_payer_notes":"APC"}]}]},{"description":"Fetal hemoglobin chemical","code_information":[{"code":"83030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.20,"maximum":21.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"}]}]},{"description":"Fetal hemoglobin assay qual","code_information":[{"code":"83033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.6,"maximum":15.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"}]}]},{"description":"Glycosylated hemoglobin test","code_information":[{"code":"83036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.22,"maximum":19.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"APC"}]}]},{"description":"Glycosylated hb home device","code_information":[{"code":"83037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.22,"maximum":19.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"APC"}]}]},{"description":"Blood methemoglobin test","code_information":[{"code":"83045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.17,"maximum":12.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"}]}]},{"description":"Blood methemoglobin assay","code_information":[{"code":"83050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.79,"maximum":16.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"}]}]},{"description":"Assay of plasma hemoglobin","code_information":[{"code":"83051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.94,"maximum":14.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.68,"additional_payer_notes":"APC"}]}]},{"description":"Blood sulfhemoglobin assay","code_information":[{"code":"83060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.36,"maximum":17.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay of hemoglobin heat","code_information":[{"code":"83065","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.55,"maximum":17.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.45,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin stability screen","code_information":[{"code":"83068","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.00,"maximum":18.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine hemoglobin","code_information":[{"code":"83069","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.75,"maximum":7.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of hemosiderin qual","code_information":[{"code":"83070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.51,"maximum":9.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.99,"additional_payer_notes":"APC"}]}]},{"description":"Assay of b hexosaminidase","code_information":[{"code":"83080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.03,"maximum":33.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"}]}]},{"description":"Assay of histamine","code_information":[{"code":"83088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.05,"maximum":58.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.01,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Homocystine","code_information":[{"code":"83090","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.02,"maximum":35.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.46,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of homovanillic acid","code_information":[{"code":"83150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.29,"maximum":44.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.53,"additional_payer_notes":"APC"}]}]},{"description":"Assay of corticosteroids 17","code_information":[{"code":"83491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.00,"maximum":35.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of 5-hiaa","code_information":[{"code":"83497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.26,"maximum":25.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone 17-d","code_information":[{"code":"83498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.81,"maximum":54.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.53,"additional_payer_notes":"APC"}]}]},{"description":"Assay free hydroxyproline","code_information":[{"code":"83500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.52,"maximum":45.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay total hydroxyproline","code_information":[{"code":"83505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.08,"maximum":48.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.52,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay nonantibody","code_information":[{"code":"83516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.95,"maximum":22.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay dipstick","code_information":[{"code":"83518","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.16,"maximum":19.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"}]}]},{"description":"Ria nonantibody","code_information":[{"code":"83519","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.48,"maximum":36.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay quant nos nonab","code_information":[{"code":"83520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Ig light chains free each","code_information":[{"code":"83521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay of insulin","code_information":[{"code":"83525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.86,"maximum":22.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay of insulin","code_information":[{"code":"83527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.30,"maximum":25.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of intrinsic factor","code_information":[{"code":"83528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.83,"maximum":39.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"}]}]},{"description":"Asay of interleukin-6 (il-6)","code_information":[{"code":"83529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Assay of iron","code_information":[{"code":"83540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Iron binding test","code_information":[{"code":"83550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.30,"maximum":17.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay of idh enzyme","code_information":[{"code":"83570","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.41,"maximum":17.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ketogenic steroids","code_information":[{"code":"83582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.70,"maximum":30.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"}]}]},{"description":"Assay 17- ketosteroids","code_information":[{"code":"83586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.16,"maximum":25.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"}]}]},{"description":"Fractionation ketosteroids","code_information":[{"code":"83593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.08,"maximum":56.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lactic acid","code_information":[{"code":"83605","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.99,"maximum":23.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.15,"additional_payer_notes":"APC"}]}]},{"description":"Lactate (LD) (LDH) enzyme","code_information":[{"code":"83615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.74,"maximum":12.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of ldh enzymes","code_information":[{"code":"83625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.15,"maximum":25.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.43,"additional_payer_notes":"APC"}]}]},{"description":"Lactoferrin fecal (qual)","code_information":[{"code":"83630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.72,"maximum":39.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.68,"additional_payer_notes":"APC"}]}]},{"description":"Lactoferrin fecal (quant)","code_information":[{"code":"83631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.65,"maximum":39.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"}]}]},{"description":"Placental lactogen","code_information":[{"code":"83632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.21,"maximum":40.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"}]}]},{"description":"Test urine for lactose","code_information":[{"code":"83633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.69,"maximum":22.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lead","code_information":[{"code":"83655","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.50,"maximum":24.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"}]}]},{"description":"L/s ratio fetal lung","code_information":[{"code":"83661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.89,"maximum":43.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.09,"additional_payer_notes":"APC"}]}]},{"description":"Foam stability fetal lung","code_information":[{"code":"83662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.96,"maximum":37.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.86,"additional_payer_notes":"APC"}]}]},{"description":"Fluoro polarize fetal lung","code_information":[{"code":"83663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.96,"maximum":37.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.86,"additional_payer_notes":"APC"}]}]},{"description":"Lamellar bdy fetal lung","code_information":[{"code":"83664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.35,"maximum":38.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lap enzyme","code_information":[{"code":"83670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.32,"maximum":19.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipase","code_information":[{"code":"83690","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.55,"maximum":13.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipoprotein(a)","code_information":[{"code":"83695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.60,"maximum":28.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"}]}]},{"description":"Assay Lipoprotein Pla2","code_information":[{"code":"83698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.99,"maximum":92.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.63,"additional_payer_notes":"APC"}]}]},{"description":"Lipopro bld electrophoretic","code_information":[{"code":"83700","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.70,"maximum":22.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprotein bld hr fraction","code_information":[{"code":"83701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.17,"maximum":67.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.55,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprotein bld quan part","code_information":[{"code":"83704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.48,"maximum":68.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":68.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lipoprotein","code_information":[{"code":"83718","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.78,"maximum":16.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood lipoprotein","code_information":[{"code":"83719","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.11,"maximum":25.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood lipoprotein","code_information":[{"code":"83721","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.98,"maximum":20.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.02,"additional_payer_notes":"APC"}]}]},{"description":"Lipoprtn dir meas sd ldl chl","code_information":[{"code":"83722","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.48,"maximum":68.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":68.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.9,"additional_payer_notes":"APC"}]}]},{"description":"Assay of lrh hormone","code_information":[{"code":"83727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.33,"maximum":34.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"}]}]},{"description":"Assay of magnesium","code_information":[{"code":"83735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.36,"maximum":13.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.04,"additional_payer_notes":"APC"}]}]},{"description":"Assay malate dehydrogenase","code_information":[{"code":"83775","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.00,"maximum":14.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay of manganese","code_information":[{"code":"83785","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.32,"maximum":53.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.98,"additional_payer_notes":"APC"}]}]},{"description":"Mass spectrometry qual/quan","code_information":[{"code":"83789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.90,"maximum":48.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of mercury","code_information":[{"code":"83825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.45,"maximum":32.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.07,"additional_payer_notes":"APC"}]}]},{"description":"Assay of metanephrines","code_information":[{"code":"83835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.09,"maximum":33.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of methemalbumin","code_information":[{"code":"83857","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.20,"maximum":21.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"}]}]},{"description":"Microfluid analy tears","code_information":[{"code":"83861","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.36,"maximum":44.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.6,"additional_payer_notes":"APC"}]}]},{"description":"Mucopolysaccharides","code_information":[{"code":"83864","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.08,"maximum":56.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"APC"}]}]},{"description":"Assay synovial fluid mucin","code_information":[{"code":"83872","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.57,"maximum":11.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"APC"}]}]},{"description":"Assay of csf protein","code_information":[{"code":"83873","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.34,"maximum":34.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.06,"additional_payer_notes":"APC"}]}]},{"description":"Assay of myoglobin","code_information":[{"code":"83874","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.27,"maximum":25.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"}]}]},{"description":"Assay myeloperoxidase","code_information":[{"code":"83876","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.32,"maximum":101.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":101.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of natriuretic peptide","code_information":[{"code":"83880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.30,"maximum":78.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.22,"additional_payer_notes":"APC"}]}]},{"description":"Assay nephelometry not spec","code_information":[{"code":"83883","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.92,"maximum":27.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay neurflmnt light chain","code_information":[{"code":"83884","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.42,"maximum":231.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":120.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":231.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.04,"additional_payer_notes":"APC"}]}]},{"description":"Assay of nickel","code_information":[{"code":"83885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.28,"maximum":48.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay of nucleotidase","code_information":[{"code":"83915","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.59,"maximum":22.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.71,"additional_payer_notes":"APC"}]}]},{"description":"Oligoclonal bands","code_information":[{"code":"83916","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.02,"maximum":54.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.76,"additional_payer_notes":"APC"}]}]},{"description":"Organic acids total quant","code_information":[{"code":"83918","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.42,"maximum":47.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.78,"additional_payer_notes":"APC"}]}]},{"description":"Organic acids qual each","code_information":[{"code":"83919","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.63,"maximum":32.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"}]}]},{"description":"Organic acid single quant","code_information":[{"code":"83921","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.15,"maximum":42.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood osmolality","code_information":[{"code":"83930","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.28,"maximum":13.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine osmolality","code_information":[{"code":"83935","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.48,"maximum":13.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of osteocalcin","code_information":[{"code":"83937","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.36,"maximum":59.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay of oxalate","code_information":[{"code":"83945","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.73,"maximum":28.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"}]}]},{"description":"Oncoprotein her-2/neu","code_information":[{"code":"83950","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.19,"maximum":128.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.63,"additional_payer_notes":"APC"}]}]},{"description":"Oncoprotein dcp","code_information":[{"code":"83951","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.19,"maximum":128.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.63,"additional_payer_notes":"APC"}]}]},{"description":"Assay of parathormone","code_information":[{"code":"83970","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.22,"maximum":82.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":82.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.34,"additional_payer_notes":"APC"}]}]},{"description":"Assay ph body fluid nos","code_information":[{"code":"83986","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.40,"maximum":7.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.76,"additional_payer_notes":"APC"}]}]},{"description":"Exhaled breath condensate","code_information":[{"code":"83987","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.40,"maximum":7.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.83,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.76,"additional_payer_notes":"APC"}]}]},{"description":"Assay for calprotectin fecal","code_information":[{"code":"83993","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.65,"maximum":39.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.61,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood pku","code_information":[{"code":"84030","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.22,"maximum":10.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phenylketones","code_information":[{"code":"84035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.78,"maximum":7.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.18,"additional_payer_notes":"APC"}]}]},{"description":"Assay acid phosphatase","code_information":[{"code":"84060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.26,"maximum":15.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay prostate phosphatase","code_information":[{"code":"84066","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.18,"maximum":19.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.14,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatase","code_information":[{"code":"84075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.92,"maximum":10.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatase","code_information":[{"code":"84078","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.85,"maximum":16.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.85,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay alkaline phosphatases","code_information":[{"code":"84080","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.04,"maximum":29.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.52,"additional_payer_notes":"APC"}]}]},{"description":"Assay phosphatidylglycerol","code_information":[{"code":"84081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.69,"maximum":32.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay of rbc pg6d enzyme","code_information":[{"code":"84085","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.97,"maximum":18.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay phosphohexose enzymes","code_information":[{"code":"84087","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.19,"maximum":21.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.27,"additional_payer_notes":"APC"}]}]},{"description":"Assay of phosphorus","code_information":[{"code":"84100","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.50,"maximum":9.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine phosphorus","code_information":[{"code":"84105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.49,"maximum":11.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.07,"additional_payer_notes":"APC"}]}]},{"description":"Test for porphobilinogen","code_information":[{"code":"84106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.53,"maximum":11.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of porphobilinogen","code_information":[{"code":"84110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.02,"maximum":16.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"}]}]},{"description":"Eval amniotic fluid protein","code_information":[{"code":"84112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.20,"maximum":195.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":104.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":195.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.02,"additional_payer_notes":"APC"}]}]},{"description":"Test urine for porphyrins","code_information":[{"code":"84119","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.69,"maximum":26.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.03,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine porphyrins","code_information":[{"code":"84120","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.97,"maximum":29.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces porphyrins","code_information":[{"code":"84126","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.15,"maximum":78.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.46,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.07,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum potassium","code_information":[{"code":"84132","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.52,"maximum":9.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine potassium","code_information":[{"code":"84133","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.49,"maximum":9.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.97,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prealbumin","code_information":[{"code":"84134","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.86,"maximum":29.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnanediol","code_information":[{"code":"84135","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.21,"maximum":42.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnanetriol","code_information":[{"code":"84138","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.00,"maximum":41.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pregnenolone","code_information":[{"code":"84140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.64,"maximum":41.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.7,"additional_payer_notes":"APC"}]}]},{"description":"Assay of 17-hydroxypregneno","code_information":[{"code":"84143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.67,"maximum":45.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.95,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone","code_information":[{"code":"84144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.82,"maximum":41.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"APC"}]}]},{"description":"Procalcitonin (PCT)","code_information":[{"code":"84145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.86,"maximum":54.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.58,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prolactin","code_information":[{"code":"84146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.41,"maximum":38.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay of prostaglandin","code_information":[{"code":"84150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.68,"maximum":83.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.86,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa complexed","code_information":[{"code":"84152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.47,"maximum":36.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa total","code_information":[{"code":"84153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.47,"maximum":36.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of psa free","code_information":[{"code":"84154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.47,"maximum":36.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein serum","code_information":[{"code":"84155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.49,"maximum":7.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.85,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein urine","code_information":[{"code":"84156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.49,"maximum":7.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.85,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein other","code_information":[{"code":"84157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.8,"maximum":7.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of protein any source","code_information":[{"code":"84160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.33,"maximum":11.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"}]}]},{"description":"Pappa serum","code_information":[{"code":"84163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.30,"maximum":30.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"}]}]},{"description":"Protein e-phoresis serum","code_information":[{"code":"84165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.20,"maximum":21.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"}]}]},{"description":"Protein e-phoresis/urine/csf","code_information":[{"code":"84166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.94,"maximum":35.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.72,"additional_payer_notes":"APC"}]}]},{"description":"Western blot test","code_information":[{"code":"84181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.18,"maximum":33.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"}]}]},{"description":"Protein western blot test","code_information":[{"code":"84182","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.75,"maximum":58.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.09,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.67,"additional_payer_notes":"APC"}]}]},{"description":"Assay RBC protoporphyrin","code_information":[{"code":"84202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.63,"maximum":28.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.07,"additional_payer_notes":"APC"}]}]},{"description":"Test RBC protoporphyrin","code_information":[{"code":"84203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.25,"maximum":19.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"}]}]},{"description":"Assay of proinsulin","code_information":[{"code":"84206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.36,"maximum":53.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.02,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-6","code_information":[{"code":"84207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.70,"maximum":56.04,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56.04,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.51,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pyruvate","code_information":[{"code":"84210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.76,"maximum":28.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"APC"}]}]},{"description":"Assay of pyruvate kinase","code_information":[{"code":"84220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.97,"maximum":18.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of quinine","code_information":[{"code":"84228","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.05,"maximum":23.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"}]}]},{"description":"Assay of estrogen","code_information":[{"code":"84233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":83.49,"maximum":175.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":94.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":175.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":92.27,"additional_payer_notes":"APC"}]}]},{"description":"Assay of progesterone","code_information":[{"code":"84234","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":61.64,"maximum":129.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":129.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.12,"additional_payer_notes":"APC"}]}]},{"description":"Assay of endocrine hormone","code_information":[{"code":"84235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":67.67,"maximum":142.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":76.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":142.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay nonendocrine receptor","code_information":[{"code":"84238","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.74,"maximum":72.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of renin","code_information":[{"code":"84244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.89,"maximum":43.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-2","code_information":[{"code":"84252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.23,"maximum":40.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"}]}]},{"description":"Assay of selenium","code_information":[{"code":"84255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.25,"maximum":50.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.81,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serotonin","code_information":[{"code":"84260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.43,"maximum":61.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":61.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.53,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sex hormone globul","code_information":[{"code":"84270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.64,"maximum":43.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.82,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sialic acid","code_information":[{"code":"84275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.77,"maximum":26.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of silica","code_information":[{"code":"84285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.95,"maximum":50.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of serum sodium","code_information":[{"code":"84295","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.57,"maximum":9.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine sodium","code_information":[{"code":"84300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.81,"maximum":10.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.31,"additional_payer_notes":"APC"}]}]},{"description":"Assay of sweat sodium","code_information":[{"code":"84302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.62,"maximum":9.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay of somatomedin","code_information":[{"code":"84305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.20,"maximum":42.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.32,"additional_payer_notes":"APC"}]}]},{"description":"Assay of somatostatin","code_information":[{"code":"84307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.37,"maximum":36.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"}]}]},{"description":"Spectrophotometry","code_information":[{"code":"84311","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.70,"maximum":16.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.51,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid specific gravity","code_information":[{"code":"84315","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.12,"maximum":6.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.44,"additional_payer_notes":"APC"}]}]},{"description":"Chromatogram assay sugars","code_information":[{"code":"84375","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.05,"maximum":77.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":77.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.95,"additional_payer_notes":"APC"}]}]},{"description":"Sugars single qual","code_information":[{"code":"84376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.22,"maximum":10.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"}]}]},{"description":"Sugars multiple qual","code_information":[{"code":"84377","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.22,"maximum":10.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"}]}]},{"description":"Sugars single quant","code_information":[{"code":"84378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.95,"maximum":22.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Sugars multiple quant","code_information":[{"code":"84379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.95,"maximum":22.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine sulfate","code_information":[{"code":"84392","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.22,"maximum":10.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"}]}]},{"description":"Tau phosphorylated ea","code_information":[{"code":"84393","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.47,"maximum":257.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":257.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.37,"additional_payer_notes":"APC"}]}]},{"description":"Total tau","code_information":[{"code":"84394","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.47,"maximum":257.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":257.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.37,"additional_payer_notes":"APC"}]}]},{"description":"Assay of free testosterone","code_information":[{"code":"84402","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.20,"maximum":50.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.74,"additional_payer_notes":"APC"}]}]},{"description":"Assay of total testosterone","code_information":[{"code":"84403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.52,"maximum":51.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.1,"additional_payer_notes":"APC"}]}]},{"description":"Testosterone bioavailable","code_information":[{"code":"84410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.72,"maximum":102.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.84,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin b-1","code_information":[{"code":"84425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.17,"maximum":42.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.29,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thiocyanate","code_information":[{"code":"84430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.05,"maximum":23.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"}]}]},{"description":"Thromboxane urine","code_information":[{"code":"84431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.35,"maximum":70.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.87,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroglobulin","code_information":[{"code":"84432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.26,"maximum":32.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"}]}]},{"description":"Asy thiopurin s-mthyltrnsfrs","code_information":[{"code":"84433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.06,"maximum":44.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of total thyroxine","code_information":[{"code":"84436","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.53,"maximum":13.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.21,"additional_payer_notes":"APC"}]}]},{"description":"Assay of neonatal thyroxine","code_information":[{"code":"84437","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay of free thyroxine","code_information":[{"code":"84439","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.57,"maximum":17.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroid activity","code_information":[{"code":"84442","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.04,"maximum":29.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.52,"additional_payer_notes":"APC"}]}]},{"description":"Assay thyroid stim hormone","code_information":[{"code":"84443","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.96,"maximum":33.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tsi globulin","code_information":[{"code":"84445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.32,"maximum":101.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":101.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin e","code_information":[{"code":"84446","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.47,"maximum":28.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"}]}]},{"description":"Assay of transcortin","code_information":[{"code":"84449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.1,"maximum":35.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.9,"additional_payer_notes":"APC"}]}]},{"description":"Transferase (AST) (SGOT)","code_information":[{"code":"84450","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.92,"maximum":10.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"}]}]},{"description":"Alanine amino (ALT) (SGPT)","code_information":[{"code":"84460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.04,"maximum":10.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.46,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of transferrin","code_information":[{"code":"84466","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.12,"maximum":25.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"}]}]},{"description":"Assay of triglycerides","code_information":[{"code":"84478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.45,"maximum":11.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.03,"additional_payer_notes":"APC"}]}]},{"description":"Assay of thyroid (t3 or t4)","code_information":[{"code":"84479","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Assay triiodothyronine (t3)","code_information":[{"code":"84480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.47,"maximum":28.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"}]}]},{"description":"Free assay (FT-3)","code_information":[{"code":"84481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.09,"maximum":33.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"}]}]},{"description":"T3 reverse","code_information":[{"code":"84482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.97,"maximum":31.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"}]}]},{"description":"Assay of troponin quant","code_information":[{"code":"84484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.85,"maximum":24.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay duodenal fluid trypsin","code_information":[{"code":"84485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.84,"maximum":14.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.56,"additional_payer_notes":"APC"}]}]},{"description":"Test feces for trypsin","code_information":[{"code":"84488","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.94,"maximum":14.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces for trypsin","code_information":[{"code":"84490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.43,"maximum":19.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.43,"additional_payer_notes":"APC"}]}]},{"description":"Assay of tyrosine","code_information":[{"code":"84510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.10,"maximum":21.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.16,"additional_payer_notes":"APC"}]}]},{"description":"Assay of troponin qual","code_information":[{"code":"84512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.59,"maximum":20.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urea nitrogen","code_information":[{"code":"84520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.75,"maximum":7.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.15,"additional_payer_notes":"APC"}]}]},{"description":"Urea nitrogen semi-quant","code_information":[{"code":"84525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.87,"maximum":10.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine/urea-n","code_information":[{"code":"84540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.28,"maximum":11.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"}]}]},{"description":"Urea-N clearance test","code_information":[{"code":"84545","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.84,"maximum":14.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of blood/uric acid","code_information":[{"code":"84550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.29,"maximum":9.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine/uric acid","code_information":[{"code":"84560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.83,"maximum":10.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.33,"additional_payer_notes":"APC"}]}]},{"description":"Assay of feces/urobilinogen","code_information":[{"code":"84577","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.96,"maximum":33.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.64,"additional_payer_notes":"APC"}]}]},{"description":"Test urine urobilinogen","code_information":[{"code":"84578","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.25,"maximum":8.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine urobilinogen","code_information":[{"code":"84580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.07,"maximum":19.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine urobilinogen","code_information":[{"code":"84583","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.75,"maximum":12.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"}]}]},{"description":"Assay of urine vma","code_information":[{"code":"84585","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.72,"maximum":30.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.28,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vip","code_information":[{"code":"84586","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.56,"maximum":70.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.1,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vasopressin","code_information":[{"code":"84588","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.24,"maximum":67.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.64,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin a","code_information":[{"code":"84590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.03,"maximum":23.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.19,"additional_payer_notes":"APC"}]}]},{"description":"Assay Of Nos Vitamin","code_information":[{"code":"84591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.21,"maximum":34.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.91,"additional_payer_notes":"APC"}]}]},{"description":"Assay of vitamin k","code_information":[{"code":"84597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.03,"maximum":27.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"}]}]},{"description":"Assay of volatiles","code_information":[{"code":"84600","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.25,"maximum":34.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.97,"additional_payer_notes":"APC"}]}]},{"description":"Xylose tolerance test","code_information":[{"code":"84620","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.26,"maximum":25.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"}]}]},{"description":"Assay of zinc","code_information":[{"code":"84630","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.82,"maximum":22.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"}]}]},{"description":"Assay of c-peptide","code_information":[{"code":"84681","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.77,"maximum":41.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"}]}]},{"description":"Chorionic gonadotropin test","code_information":[{"code":"84702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.30,"maximum":30.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"}]}]},{"description":"Chorionic gonadotropin assay","code_information":[{"code":"84703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.14,"maximum":15.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.9,"additional_payer_notes":"APC"}]}]},{"description":"Hcg free betachain test","code_information":[{"code":"84704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.53,"maximum":30.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"}]}]},{"description":"Ovulation tests","code_information":[{"code":"84830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.06,"maximum":25.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"}]}]},{"description":"Bleeding time test","code_information":[{"code":"85002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.58,"maximum":9.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.06,"additional_payer_notes":"APC"}]}]},{"description":"Automated diff wbc count","code_information":[{"code":"85004","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Bl smear w/diff wbc count","code_information":[{"code":"85007","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.61,"maximum":7.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.99,"additional_payer_notes":"APC"}]}]},{"description":"Bl smear w/o diff wbc count","code_information":[{"code":"85008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.26,"maximum":6.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.6,"additional_payer_notes":"APC"}]}]},{"description":"Manual diff wbc count b-coat","code_information":[{"code":"85009","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.82,"maximum":10.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"}]}]},{"description":"Spun microhematocrit","code_information":[{"code":"85013","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.65,"maximum":13.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.35,"additional_payer_notes":"APC"}]}]},{"description":"Hematocrit","code_information":[{"code":"85014","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.25,"maximum":4.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.49,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin","code_information":[{"code":"85018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.25,"maximum":4.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":4.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.49,"additional_payer_notes":"APC"}]}]},{"description":"Complete cbc w/auto diff wbc","code_information":[{"code":"85025","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.38,"maximum":15.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"}]}]},{"description":"Complete cbc automated","code_information":[{"code":"85027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Manual cell count each","code_information":[{"code":"85032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.09,"maximum":8.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"}]}]},{"description":"Automated rbc count","code_information":[{"code":"85041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.87,"maximum":6.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":6.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":3.17,"additional_payer_notes":"APC"}]}]},{"description":"Manual reticulocyte count","code_information":[{"code":"85044","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.09,"maximum":8.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"}]}]},{"description":"Automated reticulocyte count","code_information":[{"code":"85045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.79,"maximum":7.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.19,"additional_payer_notes":"APC"}]}]},{"description":"Reticyte/hgb concentrate","code_information":[{"code":"85046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.29,"maximum":11.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.85,"additional_payer_notes":"APC"}]}]},{"description":"Automated leukocyte count","code_information":[{"code":"85048","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.41,"maximum":5.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.67,"additional_payer_notes":"APC"}]}]},{"description":"Automated platelet count","code_information":[{"code":"85049","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.26,"maximum":8.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"APC"}]}]},{"description":"Reticulated platelet assay","code_information":[{"code":"85055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.95,"maximum":71.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":71.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.53,"additional_payer_notes":"APC"}]}]},{"description":"Chromogenic substrate assay","code_information":[{"code":"85130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.30,"maximum":23.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"}]}]},{"description":"Blood clot retraction","code_information":[{"code":"85170","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.48,"maximum":32.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"}]}]},{"description":"Blood clot lysis time","code_information":[{"code":"85175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.35,"maximum":40.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.39,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor ii prothrom spec","code_information":[{"code":"85210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.33,"maximum":25.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.63,"additional_payer_notes":"APC"}]}]},{"description":"Blooc clot factor v test","code_information":[{"code":"85220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.77,"maximum":35.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.18,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.53,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor vii proconvertin","code_information":[{"code":"85230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.00,"maximum":35.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii ahg 1 stage","code_information":[{"code":"85240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.00,"maximum":35.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii reltd antgn","code_information":[{"code":"85244","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.40,"maximum":40.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.44,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii vw ristoctn","code_information":[{"code":"85245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.79,"maximum":45.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.09,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii vw antigen","code_information":[{"code":"85246","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.79,"maximum":45.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.09,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor viii multimetric","code_information":[{"code":"85247","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.79,"maximum":45.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.09,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor ix ptc/chrstmas","code_information":[{"code":"85250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.09,"maximum":37.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor x stuart-power","code_information":[{"code":"85260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.00,"maximum":35.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xi pta","code_information":[{"code":"85270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.00,"maximum":35.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.79,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xii hageman","code_information":[{"code":"85280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.38,"maximum":38.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xiii fibrin stab","code_information":[{"code":"85290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.52,"maximum":32.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor xiii fibrin scrn","code_information":[{"code":"85291","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.65,"maximum":18.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.57,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor fletcher fact","code_information":[{"code":"85292","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":37.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"APC"}]}]},{"description":"Clot factor wght kininogen","code_information":[{"code":"85293","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.98,"maximum":37.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"APC"}]}]},{"description":"Antithrombin iii activity","code_information":[{"code":"85300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.26,"maximum":23.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"APC"}]}]},{"description":"Antithrombin iii antigen","code_information":[{"code":"85301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.27,"maximum":21.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.46,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.35,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot c antigen","code_information":[{"code":"85302","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.41,"maximum":23.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.61,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot c activity","code_information":[{"code":"85303","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.15,"maximum":27.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot s total","code_information":[{"code":"85305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.03,"maximum":23.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.19,"additional_payer_notes":"APC"}]}]},{"description":"Clot inhibit prot s free","code_information":[{"code":"85306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.55,"maximum":30.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"}]}]},{"description":"Assay Activated Protein C","code_information":[{"code":"85307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.55,"maximum":30.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"}]}]},{"description":"Factor inhibitor test","code_information":[{"code":"85335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.23,"maximum":25.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"}]}]},{"description":"Thrombomodulin","code_information":[{"code":"85337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.41,"maximum":34.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.48,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time lee & white","code_information":[{"code":"85345","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.46,"maximum":9.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time activated","code_information":[{"code":"85347","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.07,"maximum":8.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"}]}]},{"description":"Coagulation time otr method","code_information":[{"code":"85348","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.27,"maximum":8.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.71,"additional_payer_notes":"APC"}]}]},{"description":"Euglobulin lysis","code_information":[{"code":"85360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.99,"maximum":16.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.83,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradation products","code_information":[{"code":"85362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.55,"maximum":13.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.23,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen test","code_information":[{"code":"85366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":76.44,"maximum":160.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":160.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.48,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen test","code_information":[{"code":"85370","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.81,"maximum":24.79,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.79,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degrade semiquant","code_information":[{"code":"85378","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.23,"maximum":19.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradation quant","code_information":[{"code":"85379","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.67,"maximum":20.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"}]}]},{"description":"Fibrin degradj d-dimer","code_information":[{"code":"85380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.67,"maximum":20.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen activity","code_information":[{"code":"85384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.23,"maximum":19.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinogen antigen","code_information":[{"code":"85385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.74,"maximum":28.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.18,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolysins screen i&r","code_information":[{"code":"85390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.71,"maximum":30.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.25,"additional_payer_notes":"APC"}]}]},{"description":"Clotting funct activity","code_information":[{"code":"85397","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.32,"maximum":61.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":61.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.4,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasmin","code_information":[{"code":"85400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.32,"maximum":15.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic antiplasmin","code_information":[{"code":"85410","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.32,"maximum":15.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85415","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.33,"maximum":34.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.20,"maximum":13.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"}]}]},{"description":"Fibrinolytic plasminogen","code_information":[{"code":"85421","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.67,"maximum":20.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"}]}]},{"description":"Heinz bodies direct","code_information":[{"code":"85441","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.99,"maximum":8.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.41,"additional_payer_notes":"APC"}]}]},{"description":"Heinz bodies induced","code_information":[{"code":"85445","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.48,"maximum":13.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.16,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin fetal","code_information":[{"code":"85460","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.34,"maximum":15.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.12,"additional_payer_notes":"APC"}]}]},{"description":"Hemoglobin fetal","code_information":[{"code":"85461","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.89,"maximum":18.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.83,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysin acid","code_information":[{"code":"85475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.43,"maximum":17.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.31,"additional_payer_notes":"APC"}]}]},{"description":"Heparin assay","code_information":[{"code":"85520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.44,"maximum":26.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"}]}]},{"description":"Heparin neutralization","code_information":[{"code":"85525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.25,"maximum":23.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.43,"additional_payer_notes":"APC"}]}]},{"description":"Heparin-protamine tolerance","code_information":[{"code":"85530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.44,"maximum":26.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"}]}]},{"description":"Iron Stain Peripheral Blood","code_information":[{"code":"85536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.54,"maximum":13.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.22,"additional_payer_notes":"APC"}]}]},{"description":"Wbc alkaline phosphatase","code_information":[{"code":"85540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":17.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"}]}]},{"description":"RBC mechanical fragility","code_information":[{"code":"85547","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.17,"maximum":17.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"}]}]},{"description":"Muramidase","code_information":[{"code":"85549","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.81,"maximum":37.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":37.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"}]}]},{"description":"RBC osmotic fragility","code_information":[{"code":"85555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.10,"maximum":14.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.84,"additional_payer_notes":"APC"}]}]},{"description":"RBC osmotic fragility","code_information":[{"code":"85557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.69,"maximum":26.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.03,"additional_payer_notes":"APC"}]}]},{"description":"Blood platelet aggregation","code_information":[{"code":"85576","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.66,"maximum":49.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.16,"additional_payer_notes":"APC"}]}]},{"description":"Phospholipid pltlt neutraliz","code_information":[{"code":"85597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.08,"maximum":35.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.88,"additional_payer_notes":"APC"}]}]},{"description":"Hexagnal phosph pltlt neutrl","code_information":[{"code":"85598","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.08,"maximum":35.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.88,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin time","code_information":[{"code":"85610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.08,"maximum":8.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.5,"additional_payer_notes":"APC"}]}]},{"description":"Prothrombin test","code_information":[{"code":"85611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":3.74,"maximum":7.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":7.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.14,"additional_payer_notes":"APC"}]}]},{"description":"Viper venom prothrombin time","code_information":[{"code":"85612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.62,"maximum":34.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.45,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"}]}]},{"description":"Russell viper venom diluted","code_information":[{"code":"85613","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.10,"maximum":19.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.06,"additional_payer_notes":"APC"}]}]},{"description":"Reptilase test","code_information":[{"code":"85635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.36,"maximum":19.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"APC"}]}]},{"description":"Rbc sed rate nonautomated","code_information":[{"code":"85651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.06,"maximum":8.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Rbc sed rate automated","code_information":[{"code":"85652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":2.56,"maximum":5.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":3.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":5.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":2.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":2.84,"additional_payer_notes":"APC"}]}]},{"description":"RBC sickle cell test","code_information":[{"code":"85660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.23,"maximum":10.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"}]}]},{"description":"Thrombin time plasma","code_information":[{"code":"85670","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.48,"maximum":11.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"}]}]},{"description":"Thrombin time titer","code_information":[{"code":"85675","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.51,"maximum":13.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin inhibition","code_information":[{"code":"85705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.15,"maximum":19.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin time partial","code_information":[{"code":"85730","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.71,"maximum":11.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.31,"additional_payer_notes":"APC"}]}]},{"description":"Thromboplastin time partial","code_information":[{"code":"85732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Blood viscosity examination","code_information":[{"code":"85810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.09,"maximum":23.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"}]}]},{"description":"Agglutinins febrile antigen","code_information":[{"code":"86000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.63,"maximum":13.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.33,"additional_payer_notes":"APC"}]}]},{"description":"Allergen Specific Igg","code_information":[{"code":"86001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.43,"maximum":15.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.21,"additional_payer_notes":"APC"}]}]},{"description":"Allergen specific IgE","code_information":[{"code":"86003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.96,"maximum":10.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"APC"}]}]},{"description":"Allergen specific IgE","code_information":[{"code":"86005","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.57,"maximum":15.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.37,"additional_payer_notes":"APC"}]}]},{"description":"Allg spec ige recomb ea","code_information":[{"code":"86008","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.03,"maximum":35.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"}]}]},{"description":"Actin antibody each","code_information":[{"code":"86015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"WBC antibody identification","code_information":[{"code":"86021","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.30,"maximum":30.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"}]}]},{"description":"Platelet antibodies","code_information":[{"code":"86022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.45,"maximum":36.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.29,"additional_payer_notes":"APC"}]}]},{"description":"Immunoglobulin assay","code_information":[{"code":"86023","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.84,"maximum":24.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"}]}]},{"description":"Anca screen each antibody","code_information":[{"code":"86036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Anca titer each antibody","code_information":[{"code":"86037","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Antinuclear antibodies","code_information":[{"code":"86038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.49,"maximum":24.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"APC"}]}]},{"description":"Antinuclear antibodies (ANA)","code_information":[{"code":"86039","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.60,"maximum":22.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.72,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr bndng antb","code_information":[{"code":"86041","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.48,"maximum":36.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr blckg antb","code_information":[{"code":"86042","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.48,"maximum":36.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"}]}]},{"description":"Acetylcholn rcptr modlg antb","code_information":[{"code":"86043","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Aquaporin-4 antb elisa","code_information":[{"code":"86051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.95,"maximum":22.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Aquaporin-4 antb cba each","code_information":[{"code":"86052","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Aqaprn-4 antb flo cytmtry ea","code_information":[{"code":"86053","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.84,"maximum":75.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.62,"additional_payer_notes":"APC"}]}]},{"description":"Antistreptolysin o titer","code_information":[{"code":"86060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.94,"maximum":14.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"APC"}]}]},{"description":"Antistreptolysin o screen","code_information":[{"code":"86063","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.48,"maximum":11.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"}]}]},{"description":"C-reactive protein","code_information":[{"code":"86140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.92,"maximum":10.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"}]}]},{"description":"C-reactive protein hs","code_information":[{"code":"86141","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.30,"maximum":25.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"APC"}]}]},{"description":"Beta-2 glycoprotein antibody","code_information":[{"code":"86146","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.18,"maximum":50.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.72,"additional_payer_notes":"APC"}]}]},{"description":"Cardiolipin antibody ea ig","code_information":[{"code":"86147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.18,"maximum":50.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.72,"additional_payer_notes":"APC"}]}]},{"description":"Anti-phospholipid antibody","code_information":[{"code":"86148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.27,"maximum":32.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"}]}]},{"description":"Cell enumeration & id","code_information":[{"code":"86152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":238.24,"maximum":500.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":268.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":258.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":238.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":250.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":260.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":278.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":500.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":263.32,"additional_payer_notes":"APC"}]}]},{"description":"Chemotaxis assay","code_information":[{"code":"86155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.19,"maximum":31.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"}]}]},{"description":"Cold agglutinin screen","code_information":[{"code":"86156","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.67,"maximum":16.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.47,"additional_payer_notes":"APC"}]}]},{"description":"Cold agglutinin titer","code_information":[{"code":"86157","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.66,"maximum":16.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.46,"additional_payer_notes":"APC"}]}]},{"description":"Complement antigen","code_information":[{"code":"86160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.4,"maximum":23.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"}]}]},{"description":"Complement/function activity","code_information":[{"code":"86161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.4,"maximum":23.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"}]}]},{"description":"Complement total (ch50)","code_information":[{"code":"86162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.30,"maximum":40.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.34,"additional_payer_notes":"APC"}]}]},{"description":"Complement fixation each","code_information":[{"code":"86171","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.51,"maximum":19.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.51,"additional_payer_notes":"APC"}]}]},{"description":"Ccp antibody","code_information":[{"code":"86200","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.30,"maximum":25.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.6,"additional_payer_notes":"APC"}]}]},{"description":"Deoxyribonuclease antibody","code_information":[{"code":"86215","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":26.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Dna antibody native","code_information":[{"code":"86225","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.05,"maximum":27.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"}]}]},{"description":"Dna antibody single strand","code_information":[{"code":"86226","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.50,"maximum":24.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"}]}]},{"description":"Ema each ig class","code_information":[{"code":"86231","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.49,"maximum":24.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear antigen antibody","code_information":[{"code":"86235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.03,"maximum":35.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescent antibody screen","code_information":[{"code":"86255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Fluorescent antibody titer","code_information":[{"code":"86256","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Dgp antibody each ig class","code_information":[{"code":"86258","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Growth hormone antibody","code_information":[{"code":"86277","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.95,"maximum":31.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"}]}]},{"description":"Hemagglutination inhibition","code_information":[{"code":"86280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.78,"maximum":16.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor qual","code_information":[{"code":"86294","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.29,"maximum":50.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 15-3","code_information":[{"code":"86300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.77,"maximum":41.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 19-9","code_information":[{"code":"86301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.77,"maximum":41.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor ca 125","code_information":[{"code":"86304","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.77,"maximum":41.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"}]}]},{"description":"Human epididymis protein 4","code_information":[{"code":"86305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.77,"maximum":41.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody screen","code_information":[{"code":"86308","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.92,"maximum":10.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody titer","code_information":[{"code":"86309","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Heterophile antibody absrbj","code_information":[{"code":"86310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.00,"maximum":14.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay tumor other","code_information":[{"code":"86316","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.77,"maximum":41.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":41.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.85,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay infectious agent","code_information":[{"code":"86317","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.24,"maximum":29.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.74,"additional_payer_notes":"APC"}]}]},{"description":"Immunoassay infectious agent","code_information":[{"code":"86318","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.19,"maximum":36.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.99,"additional_payer_notes":"APC"}]}]},{"description":"Serum immunoelectrophoresis","code_information":[{"code":"86320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.42,"maximum":59.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.42,"additional_payer_notes":"APC"}]}]},{"description":"Other immunoelectrophoresis","code_information":[{"code":"86325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.97,"maximum":46.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":46.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.29,"additional_payer_notes":"APC"}]}]},{"description":"Ia nfct ab sarscov2 covid19","code_information":[{"code":"86328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":43.02,"maximum":90.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":90.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.54,"additional_payer_notes":"APC"}]}]},{"description":"Immunodiffusion nes","code_information":[{"code":"86329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.35,"maximum":28.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.75,"additional_payer_notes":"APC"}]}]},{"description":"Immunodiffusion ouchterlony","code_information":[{"code":"86331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Immune complex assay","code_information":[{"code":"86332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.15,"maximum":48.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.59,"additional_payer_notes":"APC"}]}]},{"description":"Immunofix e-phoresis serum","code_information":[{"code":"86334","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.22,"maximum":44.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.84,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.46,"additional_payer_notes":"APC"}]}]},{"description":"Immunfix e-phorsis/urine/csf","code_information":[{"code":"86335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.88,"maximum":58.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.82,"additional_payer_notes":"APC"}]}]},{"description":"Inhibin A","code_information":[{"code":"86336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.81,"maximum":31.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"}]}]},{"description":"Insulin antibodies","code_information":[{"code":"86337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.34,"maximum":42.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.48,"additional_payer_notes":"APC"}]}]},{"description":"Intrinsic factor antibody","code_information":[{"code":"86340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.33,"maximum":30.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.83,"additional_payer_notes":"APC"}]}]},{"description":"Islet cell antibody","code_information":[{"code":"86341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.39,"maximum":47.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.39,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.75,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte histamine release","code_information":[{"code":"86343","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.84,"maximum":24.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte phagocytosis","code_information":[{"code":"86344","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.87,"maximum":20.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.91,"additional_payer_notes":"APC"}]}]},{"description":"Cell function assay w/stim","code_information":[{"code":"86352","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.07,"maximum":270.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":270.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142.65,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocyte transformation","code_information":[{"code":"86353","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.58,"maximum":97.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":97.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.48,"additional_payer_notes":"APC"}]}]},{"description":"B cells total count","code_information":[{"code":"86355","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.84,"maximum":75.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.62,"additional_payer_notes":"APC"}]}]},{"description":"Mononuclear cell antigen","code_information":[{"code":"86356","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.44,"maximum":53.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"APC"}]}]},{"description":"Nk cells total count","code_information":[{"code":"86357","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.84,"maximum":75.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.62,"additional_payer_notes":"APC"}]}]},{"description":"T cells total count","code_information":[{"code":"86359","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.84,"maximum":75.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.62,"additional_payer_notes":"APC"}]}]},{"description":"T cell absolute count/ratio","code_information":[{"code":"86360","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.63,"maximum":93.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":93.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.33,"additional_payer_notes":"APC"}]}]},{"description":"T cell absolute count","code_information":[{"code":"86361","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.44,"maximum":53.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.12,"additional_payer_notes":"APC"}]}]},{"description":"Mog-igg1 antb cba each","code_information":[{"code":"86362","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Mog-igg1 antb flo cytmtry ea","code_information":[{"code":"86363","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.84,"maximum":75.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.62,"additional_payer_notes":"APC"}]}]},{"description":"Tiss trnsgltmnase ea ig clas","code_information":[{"code":"86364","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.95,"maximum":22.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Muscle-specific kinase antb","code_information":[{"code":"86366","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.48,"maximum":36.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"}]}]},{"description":"Stem cells total count","code_information":[{"code":"86367","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":73.89,"maximum":155.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":155.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":81.67,"additional_payer_notes":"APC"}]}]},{"description":"Microsomal antibody each","code_information":[{"code":"86376","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.82,"maximum":29.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.28,"additional_payer_notes":"APC"}]}]},{"description":"Mitochondrial antibody each","code_information":[{"code":"86381","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.18,"maximum":50.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.72,"additional_payer_notes":"APC"}]}]},{"description":"Neutralization test viral","code_information":[{"code":"86382","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.06,"maximum":33.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.76,"additional_payer_notes":"APC"}]}]},{"description":"Nitroblue tetrazolium dye","code_information":[{"code":"86384","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.93,"maximum":27.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"}]}]},{"description":"Nuclear matrix protein 22","code_information":[{"code":"86386","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.69,"maximum":43.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.87,"additional_payer_notes":"APC"}]}]},{"description":"Particle agglut antbdy scrn","code_information":[{"code":"86403","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.96,"maximum":23.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"}]}]},{"description":"Particle agglut antbdy titr","code_information":[{"code":"86406","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.11,"maximum":21.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"}]}]},{"description":"Neutrlzg antb sarscov2 scr","code_information":[{"code":"86408","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.02,"maximum":84.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.24,"additional_payer_notes":"APC"}]}]},{"description":"Neutrlzg antb sarscov2 titer","code_information":[{"code":"86409","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":75.63,"maximum":158.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":75.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":158.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":83.59,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 antb quantitative","code_information":[{"code":"86413","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.86,"maximum":102.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":55.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.0,"additional_payer_notes":"APC"}]}]},{"description":"Rheumatoid factor test qual","code_information":[{"code":"86430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.83,"maximum":12.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.45,"additional_payer_notes":"APC"}]}]},{"description":"Rheumatoid factor quant","code_information":[{"code":"86431","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.39,"maximum":11.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"}]}]},{"description":"Tb test cell immun measure","code_information":[{"code":"86480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":58.88,"maximum":123.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":123.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.08,"additional_payer_notes":"APC"}]}]},{"description":"Tb ag response t-cell susp","code_information":[{"code":"86481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.0,"maximum":199.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":111.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":199.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.0,"additional_payer_notes":"APC"}]}]},{"description":"Strptcs pneum antb serot ia","code_information":[{"code":"86581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":87.43,"maximum":183.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":92.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":183.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":96.63,"additional_payer_notes":"APC"}]}]},{"description":"Streptokinase antibody","code_information":[{"code":"86590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.03,"maximum":25.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis test non-trep qual","code_information":[{"code":"86592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.06,"maximum":8.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Syphilis test non-trep quant","code_information":[{"code":"86593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.18,"maximum":8.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.62,"additional_payer_notes":"APC"}]}]},{"description":"Voltage-gtd ca chnl antb ea","code_information":[{"code":"86596","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Antinomyces antibody","code_information":[{"code":"86602","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.67,"maximum":20.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus antibody","code_information":[{"code":"86603","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.23,"maximum":25.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"}]}]},{"description":"Aspergillus antibody","code_information":[{"code":"86606","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.30,"maximum":30.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.8,"additional_payer_notes":"APC"}]}]},{"description":"Bacterium antibody","code_information":[{"code":"86609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.24,"maximum":25.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella Antibody","code_information":[{"code":"86611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.67,"maximum":20.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"}]}]},{"description":"Blastomyces antibody","code_information":[{"code":"86612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.26,"maximum":25.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"}]}]},{"description":"Bordetella antibody","code_information":[{"code":"86615","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Lyme disease antibody","code_information":[{"code":"86617","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.72,"maximum":30.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"APC"}]}]},{"description":"Lyme disease antibody","code_information":[{"code":"86618","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.18,"maximum":33.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.88,"additional_payer_notes":"APC"}]}]},{"description":"Borrelia antibody","code_information":[{"code":"86619","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.71,"maximum":26.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.05,"additional_payer_notes":"APC"}]}]},{"description":"Brucella antibody","code_information":[{"code":"86622","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.48,"maximum":17.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"}]}]},{"description":"Campylobacter antibody","code_information":[{"code":"86625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.46,"maximum":26.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"}]}]},{"description":"Candida antibody","code_information":[{"code":"86628","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.41,"maximum":23.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.36,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.61,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia antibody","code_information":[{"code":"86631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.23,"maximum":23.57,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.57,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia igm antibody","code_information":[{"code":"86632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.05,"maximum":25.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"}]}]},{"description":"Coccidioides antibody","code_information":[{"code":"86635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.90,"maximum":22.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.04,"additional_payer_notes":"APC"}]}]},{"description":"Q fever antibody","code_information":[{"code":"86638","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.51,"maximum":24.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"}]}]},{"description":"Cryptococcus antibody","code_information":[{"code":"86641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.69,"maximum":28.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"}]}]},{"description":"CMV antibody","code_information":[{"code":"86644","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.67,"maximum":28.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"}]}]},{"description":"Cmv antibody igm","code_information":[{"code":"86645","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.01,"maximum":33.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"}]}]},{"description":"Diphtheria antibody","code_information":[{"code":"86648","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.45,"maximum":30.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.97,"additional_payer_notes":"APC"}]}]},{"description":"Encephalitis californ antbdy","code_information":[{"code":"86651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis east eqne anbdy","code_information":[{"code":"86652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis st louis antbody","code_information":[{"code":"86653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Encephaltis west eqne antbdy","code_information":[{"code":"86654","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus antibody","code_information":[{"code":"86658","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.38,"maximum":25.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.68,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr antibody","code_information":[{"code":"86663","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.46,"maximum":26.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr nuclear antigen","code_information":[{"code":"86664","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.53,"maximum":30.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"}]}]},{"description":"Epstein-barr capsid vca","code_information":[{"code":"86665","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.23,"maximum":36.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"APC"}]}]},{"description":"Ehrlichia Antibody","code_information":[{"code":"86666","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.67,"maximum":20.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"}]}]},{"description":"Francisella tularensis","code_information":[{"code":"86668","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.45,"maximum":28.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.87,"additional_payer_notes":"APC"}]}]},{"description":"Fungus nes antibody","code_information":[{"code":"86671","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.64,"maximum":24.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"APC"}]}]},{"description":"Giardia lamblia antibody","code_information":[{"code":"86674","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.98,"maximum":29.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.46,"additional_payer_notes":"APC"}]}]},{"description":"Helicobacter pylori antibody","code_information":[{"code":"86677","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.01,"maximum":33.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"}]}]},{"description":"Helminth antibody","code_information":[{"code":"86682","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.36,"maximum":25.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"APC"}]}]},{"description":"Hemophilus influenza antibdy","code_information":[{"code":"86684","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.05,"maximum":31.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"}]}]},{"description":"Htlv-i antibody","code_information":[{"code":"86687","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.64,"maximum":18.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.54,"additional_payer_notes":"APC"}]}]},{"description":"Htlv-ii antibody","code_information":[{"code":"86688","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.3,"maximum":27.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.42,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"}]}]},{"description":"Htlv/hiv confirmj antibody","code_information":[{"code":"86689","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.38,"maximum":38.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis delta agent antbdy","code_information":[{"code":"86692","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.30,"maximum":34.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":34.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex nes antbdy","code_information":[{"code":"86694","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.67,"maximum":28.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex type 1 test","code_information":[{"code":"86695","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex type 2 test","code_information":[{"code":"86696","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.38,"maximum":38.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasma antibody","code_information":[{"code":"86698","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.10,"maximum":27.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.48,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1antibody","code_information":[{"code":"86701","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.45,"maximum":17.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.33,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 antibody","code_information":[{"code":"86702","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.84,"maximum":26.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.2,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1/hiv-2 1 result antbdy","code_information":[{"code":"86703","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.02,"maximum":27.34,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.34,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"}]}]},{"description":"Hep b core antibody total","code_information":[{"code":"86704","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Hep b core antibody igm","code_information":[{"code":"86705","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.18,"maximum":23.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"}]}]},{"description":"Hep b surface antibody","code_information":[{"code":"86706","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.20,"maximum":21.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis be antibody","code_information":[{"code":"86707","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.99,"maximum":23.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.15,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis a antibody","code_information":[{"code":"86708","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.77,"maximum":24.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis a igm antibody","code_information":[{"code":"86709","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.70,"maximum":22.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.82,"additional_payer_notes":"APC"}]}]},{"description":"Influenza virus antibody","code_information":[{"code":"86710","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.87,"maximum":27.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"}]}]},{"description":"John cunningham antibody","code_information":[{"code":"86711","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.05,"maximum":33.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.73,"additional_payer_notes":"APC"}]}]},{"description":"Legionella antibody","code_information":[{"code":"86713","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.54,"maximum":30.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"}]}]},{"description":"Leishmania antibody","code_information":[{"code":"86717","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.64,"maximum":24.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"APC"}]}]},{"description":"Leptospira antibody","code_information":[{"code":"86720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.39,"maximum":32.31,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.33,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.31,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.01,"additional_payer_notes":"APC"}]}]},{"description":"Listeria monocytogenes","code_information":[{"code":"86723","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Lymph choriomeningitis ab","code_information":[{"code":"86727","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.23,"maximum":25.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.51,"additional_payer_notes":"APC"}]}]},{"description":"Mucormycosis antibody","code_information":[{"code":"86732","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.25,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"}]}]},{"description":"Mumps antibody","code_information":[{"code":"86735","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.40,"maximum":26.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.7,"additional_payer_notes":"APC"}]}]},{"description":"Mycoplasma antibody","code_information":[{"code":"86738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.58,"maximum":26.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.9,"additional_payer_notes":"APC"}]}]},{"description":"Neisseria meningitidis","code_information":[{"code":"86741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Nocardia antibody","code_information":[{"code":"86744","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.19,"maximum":31.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"APC"}]}]},{"description":"Parvovirus antibody","code_information":[{"code":"86747","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.28,"maximum":29.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"APC"}]}]},{"description":"Malaria antibody","code_information":[{"code":"86750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Protozoa antibody nos","code_information":[{"code":"86753","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.77,"maximum":24.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.76,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.01,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory virus antibody","code_information":[{"code":"86756","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.10,"maximum":31.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"}]}]},{"description":"Rickettsia Antibody","code_information":[{"code":"86757","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.38,"maximum":38.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.32,"additional_payer_notes":"APC"}]}]},{"description":"Rotavirus antibody","code_information":[{"code":"86759","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.32,"maximum":36.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.14,"additional_payer_notes":"APC"}]}]},{"description":"Rubella antibody","code_information":[{"code":"86762","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.67,"maximum":28.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"}]}]},{"description":"Rubeola antibody","code_information":[{"code":"86765","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.24,"maximum":25.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"}]}]},{"description":"Salmonella antibody","code_information":[{"code":"86768","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid-19 antibody","code_information":[{"code":"86769","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.02,"maximum":84.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.24,"additional_payer_notes":"APC"}]}]},{"description":"Shigella antibody","code_information":[{"code":"86771","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.26,"maximum":48.82,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.21,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.82,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.7,"additional_payer_notes":"APC"}]}]},{"description":"Tetanus antibody","code_information":[{"code":"86774","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.06,"maximum":29.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.54,"additional_payer_notes":"APC"}]}]},{"description":"Toxoplasma antibody","code_information":[{"code":"86777","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.67,"maximum":28.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"}]}]},{"description":"Toxoplasma antibody igm","code_information":[{"code":"86778","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.69,"maximum":28.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"}]}]},{"description":"Treponema pallidum","code_information":[{"code":"86780","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.58,"maximum":26.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.9,"additional_payer_notes":"APC"}]}]},{"description":"Trichinella antibody","code_information":[{"code":"86784","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.93,"maximum":25.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"}]}]},{"description":"Varicella-zoster antibody","code_information":[{"code":"86787","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.24,"maximum":25.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"}]}]},{"description":"West nile virus ab igm","code_information":[{"code":"86788","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.01,"maximum":33.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"}]}]},{"description":"West Nile Virus Antibody","code_information":[{"code":"86789","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.67,"maximum":28.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"APC"}]}]},{"description":"Virus antibody nos","code_information":[{"code":"86790","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.24,"maximum":25.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.24,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.52,"additional_payer_notes":"APC"}]}]},{"description":"Yersinia antibody","code_information":[{"code":"86793","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.53,"maximum":26.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"}]}]},{"description":"Zika virus igm antibody","code_information":[{"code":"86794","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.01,"maximum":33.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"}]}]},{"description":"Thyroglobulin antibody","code_information":[{"code":"86800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.11,"maximum":31.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c ab test","code_information":[{"code":"86803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.56,"maximum":28.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"}]}]},{"description":"Hep c ab test confirm","code_information":[{"code":"86804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.72,"maximum":30.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.26,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocytotoxicity assay","code_information":[{"code":"86805","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":180.03,"maximum":377.94,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":202.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":195.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":189.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":197.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":377.94,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":200.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.99,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocytotoxicity assay","code_information":[{"code":"86806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.21,"maximum":94.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":94.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.97,"additional_payer_notes":"APC"}]}]},{"description":"Cytotoxic antibody screening","code_information":[{"code":"86807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":74.72,"maximum":156.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":84.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":156.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.58,"additional_payer_notes":"APC"}]}]},{"description":"Cytotoxic antibody screening","code_information":[{"code":"86808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.20,"maximum":59.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.46,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.16,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing a b or c","code_information":[{"code":"86812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.52,"maximum":51.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.1,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing a b or c","code_information":[{"code":"86813","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.1,"maximum":115.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":115.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60.9,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing dr/dq","code_information":[{"code":"86816","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.66,"maximum":60.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.55,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.68,"additional_payer_notes":"APC"}]}]},{"description":"Hla typing dr/dq","code_information":[{"code":"86817","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":100.83,"maximum":211.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":113.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.03,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":211.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":111.45,"additional_payer_notes":"APC"}]}]},{"description":"Lymphocyte culture mixed","code_information":[{"code":"86821","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.73,"maximum":72.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.73,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.39,"additional_payer_notes":"APC"}]}]},{"description":"Hla x-math non-cytotoxic","code_information":[{"code":"86825","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.02,"maximum":218.36,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":117.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.77,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.02,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":218.36,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":114.96,"additional_payer_notes":"APC"}]}]},{"description":"Hla x-match noncytotoxc addl","code_information":[{"code":"86826","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.70,"maximum":72.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.36,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i&ii antibody qual","code_information":[{"code":"86828","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.98,"maximum":128.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.4,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i/ii antibody qual","code_information":[{"code":"86829","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":60.98,"maximum":128.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":68.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":128.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.4,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i phenotype qual","code_information":[{"code":"86830","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":90.74,"maximum":190.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":190.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.3,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii phenotype qual","code_information":[{"code":"86831","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":77.79,"maximum":163.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":87.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":163.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":85.97,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i high defin qual","code_information":[{"code":"86832","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":307.56,"maximum":645.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":346.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":333.46,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":307.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":323.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":336.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":360.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":645.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":343.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.94,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii high defin qual","code_information":[{"code":"86833","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":309.51,"maximum":649.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":348.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":309.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":325.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":338.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":362.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":649.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":345.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":342.09,"additional_payer_notes":"APC"}]}]},{"description":"Hla class i semiquant panel","code_information":[{"code":"86834","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":339.68,"maximum":713.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":382.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":368.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":339.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":357.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":371.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":397.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":713.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":379.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":375.44,"additional_payer_notes":"APC"}]}]},{"description":"Hla class ii semiquant panel","code_information":[{"code":"86835","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":306.81,"maximum":644.08,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":345.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":332.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":306.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":322.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":335.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":359.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":644.08,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":342.34,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":339.11,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysins/agglutinins auto","code_information":[{"code":"86940","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.33,"maximum":17.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.38,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"APC"}]}]},{"description":"Hemolysins/agglutinins","code_information":[{"code":"86941","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.50,"maximum":24.15,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.15,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.72,"additional_payer_notes":"APC"}]}]},{"description":"Small animal inoculation","code_information":[{"code":"87003","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.00,"maximum":33.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.68,"additional_payer_notes":"APC"}]}]},{"description":"Specimen infect agnt concntj","code_information":[{"code":"87015","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.35,"maximum":13.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"}]}]},{"description":"Blood culture for bacteria","code_information":[{"code":"87040","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.80,"maximum":20.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.84,"additional_payer_notes":"APC"}]}]},{"description":"Feces culture aerobic bact","code_information":[{"code":"87045","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.97,"maximum":18.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"}]}]},{"description":"Stool cultr aerobic bact ea","code_information":[{"code":"87046","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.97,"maximum":18.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.91,"additional_payer_notes":"APC"}]}]},{"description":"Culture othr specimn aerobic","code_information":[{"code":"87070","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.19,"maximum":17.19,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.05,"additional_payer_notes":"APC"}]}]},{"description":"Culture aerobic quant other","code_information":[{"code":"87071","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.40,"maximum":19.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.89,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"}]}]},{"description":"Culture Bacteria Anaerobic","code_information":[{"code":"87073","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.18,"maximum":19.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.14,"additional_payer_notes":"APC"}]}]},{"description":"Cultr bacteria except blood","code_information":[{"code":"87075","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.00,"maximum":18.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.94,"additional_payer_notes":"APC"}]}]},{"description":"Culture anaerobe ident each","code_information":[{"code":"87076","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.68,"maximum":16.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.48,"additional_payer_notes":"APC"}]}]},{"description":"Culture Aerobic Identify","code_information":[{"code":"87077","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.68,"maximum":16.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.68,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.48,"additional_payer_notes":"APC"}]}]},{"description":"Culture screen only","code_information":[{"code":"87081","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.30,"maximum":13.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"}]}]},{"description":"Culture of specimen by kit","code_information":[{"code":"87084","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.72,"maximum":53.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.42,"additional_payer_notes":"APC"}]}]},{"description":"Urine culture/colony count","code_information":[{"code":"87086","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.67,"maximum":16.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.47,"additional_payer_notes":"APC"}]}]},{"description":"Urine bacteria culture","code_information":[{"code":"87088","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.69,"maximum":16.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.49,"additional_payer_notes":"APC"}]}]},{"description":"Skin fungi culture","code_information":[{"code":"87101","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.32,"maximum":15.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.1,"additional_payer_notes":"APC"}]}]},{"description":"Fungus isolation culture","code_information":[{"code":"87102","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.99,"maximum":16.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.41,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.83,"additional_payer_notes":"APC"}]}]},{"description":"Blood fungus culture","code_information":[{"code":"87103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.44,"maximum":40.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"}]}]},{"description":"Fungi identification yeast","code_information":[{"code":"87106","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.80,"maximum":20.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.84,"additional_payer_notes":"APC"}]}]},{"description":"Fungi identification mold","code_information":[{"code":"87107","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.80,"maximum":20.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.84,"additional_payer_notes":"APC"}]}]},{"description":"Mycoplasma","code_information":[{"code":"87109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.62,"maximum":30.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.16,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia culture","code_information":[{"code":"87110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.62,"maximum":39.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.19,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.58,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria culture","code_information":[{"code":"87116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.26,"maximum":21.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.34,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteric identification","code_information":[{"code":"87118","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.88,"maximum":29.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.63,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.34,"additional_payer_notes":"APC"}]}]},{"description":"Culture type immunofluoresc","code_information":[{"code":"87140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.29,"maximum":11.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.85,"additional_payer_notes":"APC"}]}]},{"description":"Culture typing glc/hplc","code_information":[{"code":"87143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.89,"maximum":24.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.15,"additional_payer_notes":"APC"}]}]},{"description":"Culture type immunologic","code_information":[{"code":"87147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.92,"maximum":10.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.44,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna direct probe","code_information":[{"code":"87149","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna amplified probe","code_information":[{"code":"87150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Culture Type Pulse Field Gel","code_information":[{"code":"87152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.35,"maximum":15.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"}]}]},{"description":"Dna/rna sequencing","code_information":[{"code":"87153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":109.59,"maximum":230.06,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":123.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":118.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":230.06,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":121.13,"additional_payer_notes":"APC"}]}]},{"description":"Cul typ id bld pthgn 6+ trgt","code_information":[{"code":"87154","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.16,"maximum":434.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":224.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":218.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":434.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.96,"additional_payer_notes":"APC"}]}]},{"description":"Culture typing added method","code_information":[{"code":"87158","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.35,"maximum":15.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.97,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"}]}]},{"description":"Dark field examination","code_information":[{"code":"87164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.20,"maximum":21.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.28,"additional_payer_notes":"APC"}]}]},{"description":"Dark field examination","code_information":[{"code":"87166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.74,"maximum":22.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"}]}]},{"description":"Macroscopic Exam Arthropod","code_information":[{"code":"87168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.06,"maximum":8.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Macroscopic exam parasite","code_information":[{"code":"87169","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.09,"maximum":8.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"}]}]},{"description":"Pinworm Exam","code_information":[{"code":"87172","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.06,"maximum":8.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Tissue homogenization cultr","code_information":[{"code":"87176","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.59,"maximum":11.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"}]}]},{"description":"Ova and parasites smears","code_information":[{"code":"87177","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.46,"maximum":17.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.52,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible diffuse","code_information":[{"code":"87181","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.51,"maximum":9.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.99,"additional_payer_notes":"APC"}]}]},{"description":"Sc std carbapenem resist gen","code_information":[{"code":"87183","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible disk","code_information":[{"code":"87184","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.11,"maximum":14.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.85,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible enzyme","code_information":[{"code":"87185","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.51,"maximum":9.47,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.47,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.99,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible mic","code_information":[{"code":"87186","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.22,"maximum":17.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.08,"additional_payer_notes":"APC"}]}]},{"description":"Microbe susceptible mlc","code_information":[{"code":"87187","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.16,"maximum":80.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.67,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":80.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.18,"additional_payer_notes":"APC"}]}]},{"description":"Microbe suscept macrobroth","code_information":[{"code":"87188","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.31,"maximum":13.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.97,"additional_payer_notes":"APC"}]}]},{"description":"Microbe suscept mycobacteri","code_information":[{"code":"87190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.94,"maximum":14.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.68,"additional_payer_notes":"APC"}]}]},{"description":"Bactericidal level serum","code_information":[{"code":"87197","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.27,"maximum":29.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.7,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.77,"additional_payer_notes":"APC"}]}]},{"description":"Smear gram stain","code_information":[{"code":"87205","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.06,"maximum":8.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Smear fluorescent/acid stai","code_information":[{"code":"87206","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.12,"maximum":10.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.66,"additional_payer_notes":"APC"}]}]},{"description":"Smear special stain","code_information":[{"code":"87207","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.69,"maximum":11.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.35,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"}]}]},{"description":"Smear complex stain","code_information":[{"code":"87209","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.08,"maximum":35.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.88,"additional_payer_notes":"APC"}]}]},{"description":"Smear wet mount saline/ink","code_information":[{"code":"87210","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.53,"maximum":11.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.11,"additional_payer_notes":"APC"}]}]},{"description":"Tissue exam for fungi","code_information":[{"code":"87220","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.06,"maximum":8.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Assay toxin or antitoxin","code_information":[{"code":"87230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.75,"maximum":39.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculate eggs/animal","code_information":[{"code":"87250","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.58,"maximum":39.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.54,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculation tissue","code_information":[{"code":"87252","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.77,"maximum":51.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.37,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculate tissue addl","code_information":[{"code":"87253","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.19,"maximum":40.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.19,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.21,"additional_payer_notes":"APC"}]}]},{"description":"Virus inoculation shell via","code_information":[{"code":"87254","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.58,"maximum":39.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.54,"additional_payer_notes":"APC"}]}]},{"description":"Genet virus isolate hsv","code_information":[{"code":"87255","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.17,"maximum":67.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":67.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.55,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus ag if","code_information":[{"code":"87260","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.71,"maximum":28.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.15,"additional_payer_notes":"APC"}]}]},{"description":"Pertussis ag if","code_information":[{"code":"87265","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus antibody dfa","code_information":[{"code":"87267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.75,"maximum":26.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"}]}]},{"description":"Giardia ag if","code_information":[{"code":"87269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.93,"maximum":27.14,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.56,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.14,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"APC"}]}]},{"description":"Chlamydia trachomatis ag if","code_information":[{"code":"87270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Cytomegalovirus dfa","code_information":[{"code":"87271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.75,"maximum":26.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"}]}]},{"description":"Cryptosporidium ag if","code_information":[{"code":"87272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex 2 ag if","code_information":[{"code":"87273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Herpes simplex 1 ag if","code_information":[{"code":"87274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Influenza b ag if","code_information":[{"code":"87275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.64,"maximum":24.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.64,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.86,"additional_payer_notes":"APC"}]}]},{"description":"Influenza a ag if","code_information":[{"code":"87276","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.27,"maximum":32.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumophilia ag if","code_information":[{"code":"87278","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.82,"maximum":31.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.38,"additional_payer_notes":"APC"}]}]},{"description":"Parainfluenza ag if","code_information":[{"code":"87279","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.61,"maximum":32.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.27,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.25,"additional_payer_notes":"APC"}]}]},{"description":"Respiratory syncytial ag if","code_information":[{"code":"87280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.75,"maximum":26.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"}]}]},{"description":"Pneumocystis carinii ag if","code_information":[{"code":"87281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Rubeola ag if","code_information":[{"code":"87283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":57.76,"maximum":121.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":67.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":121.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":63.84,"additional_payer_notes":"APC"}]}]},{"description":"Treponema pallidum ag if","code_information":[{"code":"87285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.57,"maximum":24.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"APC"}]}]},{"description":"Varicella zoster ag if","code_information":[{"code":"87290","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.75,"maximum":26.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"}]}]},{"description":"Antibody detection nos if","code_information":[{"code":"87299","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.30,"maximum":32.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.9,"additional_payer_notes":"APC"}]}]},{"description":"Ag detection polyval if","code_information":[{"code":"87300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus ag ia","code_information":[{"code":"87301","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Aspergillus ag ia","code_information":[{"code":"87305","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach ag ia","code_information":[{"code":"87320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.25,"maximum":29.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.68,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"}]}]},{"description":"Clostridium ag ia","code_information":[{"code":"87324","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Cryptococcus neoform ag ia","code_information":[{"code":"87327","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.75,"maximum":26.76,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.76,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.09,"additional_payer_notes":"APC"}]}]},{"description":"Cryptosporidium ag ia","code_information":[{"code":"87328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.13,"maximum":27.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.51,"additional_payer_notes":"APC"}]}]},{"description":"Giardia ag ia","code_information":[{"code":"87329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Cytomegalovirus ag ia","code_information":[{"code":"87332","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"E coli 0157 ag ia","code_information":[{"code":"87335","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.03,"maximum":25.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"}]}]},{"description":"Entamoeb hist dispr ag ia","code_information":[{"code":"87336","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.2,"maximum":31.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"}]}]},{"description":"Entamoeb hist group ag ia","code_information":[{"code":"87337","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Hpylori stool ia","code_information":[{"code":"87338","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.66,"maximum":28.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.1,"additional_payer_notes":"APC"}]}]},{"description":"H pylori ag ia","code_information":[{"code":"87339","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.2,"maximum":31.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag ia","code_information":[{"code":"87340","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.81,"maximum":20.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag ia","code_information":[{"code":"87341","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.81,"maximum":20.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.85,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis be ag ia","code_information":[{"code":"87350","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.95,"maximum":22.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":22.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.11,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis delta ag ia","code_information":[{"code":"87380","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.44,"maximum":36.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.46,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"}]}]},{"description":"Histoplasma capsul ag ia","code_information":[{"code":"87385","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.59,"maximum":26.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.25,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.04,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 ag w/hiv-1 & hiv-2 ab","code_information":[{"code":"87389","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.88,"maximum":48.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.28,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 ag ia","code_information":[{"code":"87390","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.86,"maximum":47.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.78,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.26,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 ag ia","code_information":[{"code":"87391","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.80,"maximum":43.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.0,"additional_payer_notes":"APC"}]}]},{"description":"Influenza a/b ag ia","code_information":[{"code":"87400","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.42,"maximum":28.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"}]}]},{"description":"Resp syncytial ag ia","code_information":[{"code":"87420","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.21,"maximum":27.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.21,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":27.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.61,"additional_payer_notes":"APC"}]}]},{"description":"Rotavirus ag ia","code_information":[{"code":"87425","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Coronavirus ag ia","code_information":[{"code":"87426","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.56,"maximum":70.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.1,"additional_payer_notes":"APC"}]}]},{"description":"Shiga-like toxin ag ia","code_information":[{"code":"87427","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov & inf vir a&b ag ia","code_information":[{"code":"87428","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.78,"maximum":140.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":140.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.8,"additional_payer_notes":"APC"}]}]},{"description":"Strep a ag ia","code_information":[{"code":"87430","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.97,"maximum":33.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.97,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.65,"additional_payer_notes":"APC"}]}]},{"description":"Ag detect nos ia mult","code_information":[{"code":"87449","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Ag detect polyval ia mult","code_information":[{"code":"87451","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.98,"maximum":20.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.93,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.04,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b surface ag quan","code_information":[{"code":"87467","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.05,"maximum":50.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.59,"additional_payer_notes":"APC"}]}]},{"description":"Anaplsma phgcytophlm amp prb","code_information":[{"code":"87468","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Babesia microti amp prb","code_information":[{"code":"87469","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella dna amp probe","code_information":[{"code":"87471","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Bartonella dna quant","code_information":[{"code":"87472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Lyme dis dna dir probe","code_information":[{"code":"87475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Lyme dis dna amp probe","code_information":[{"code":"87476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Borrelia miyamotoi amp prb","code_information":[{"code":"87478","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna dir probe","code_information":[{"code":"87480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna amp probe","code_information":[{"code":"87481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Candida dna quant","code_information":[{"code":"87482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":52.95,"maximum":111.16,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.95,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.98,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":111.16,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.53,"additional_payer_notes":"APC"}]}]},{"description":"Cns dna amp probe type 12-25","code_information":[{"code":"87483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Ehrlicha chaffeensis amp prb","code_information":[{"code":"87484","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna dir probe","code_information":[{"code":"87485","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna amp probe","code_information":[{"code":"87486","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd pneum dna quant","code_information":[{"code":"87487","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna dir probe","code_information":[{"code":"87490","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.61,"maximum":45.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.43,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.12,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna amp probe","code_information":[{"code":"87491","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach dna quant","code_information":[{"code":"87492","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":50.80,"maximum":106.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":57.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":106.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.14,"additional_payer_notes":"APC"}]}]},{"description":"C diff amplified probe","code_information":[{"code":"87493","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":35.41,"maximum":74.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":74.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.51,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.13,"additional_payer_notes":"APC"}]}]},{"description":"Chlmy trch&neisra gonor mult","code_information":[{"code":"87494","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.67,"maximum":139.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":139.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.69,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna dir probe","code_information":[{"code":"87495","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.53,"maximum":59.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.53,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna amp probe","code_information":[{"code":"87496","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Cytomeg dna quant","code_information":[{"code":"87497","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Enterovirus probe&revrs trns","code_information":[{"code":"87498","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Vanomycin dna amp probe","code_information":[{"code":"87500","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp prob 1+","code_information":[{"code":"87501","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.74,"maximum":102.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.88,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp probe","code_information":[{"code":"87502","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.01,"maximum":191.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.51,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.67,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.01,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":191.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.59,"additional_payer_notes":"APC"}]}]},{"description":"Influenza dna amp prob addl","code_information":[{"code":"87503","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.76,"maximum":58.27,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.27,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.68,"additional_payer_notes":"APC"}]}]},{"description":"Nfct agent detection gi","code_information":[{"code":"87505","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":121.88,"maximum":255.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":255.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134.7,"additional_payer_notes":"APC"}]}]},{"description":"Iadna-dna/rna probe tq 6-11","code_information":[{"code":"87506","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":249.84,"maximum":524.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":281.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":270.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":249.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":262.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":273.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":292.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":524.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":278.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":276.14,"additional_payer_notes":"APC"}]}]},{"description":"Iadna-dna/rna probe tq 12-25","code_information":[{"code":"87507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna dir probe","code_information":[{"code":"87510","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna amp probe","code_information":[{"code":"87511","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Gardner vag dna quant","code_information":[{"code":"87512","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.67,"maximum":83.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.85,"additional_payer_notes":"APC"}]}]},{"description":"H pylri clrthmcn rst amp prb","code_information":[{"code":"87513","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b dna amp probe","code_information":[{"code":"87516","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis b dna quant","code_information":[{"code":"87517","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c rna dir probe","code_information":[{"code":"87520","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":29.66,"maximum":62.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.41,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":62.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.78,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c probe&rvrs trnsc","code_information":[{"code":"87521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis c revrs trnscrpj","code_information":[{"code":"87522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis d quantification","code_information":[{"code":"87523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna dir probe","code_information":[{"code":"87525","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.31,"maximum":59.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.29,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna amp probe","code_information":[{"code":"87526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":37.30,"maximum":78.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.44,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.66,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":78.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.62,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.22,"additional_payer_notes":"APC"}]}]},{"description":"Hepatitis g dna quant","code_information":[{"code":"87527","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.67,"maximum":83.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.85,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna dir probe","code_information":[{"code":"87528","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna amp probe","code_information":[{"code":"87529","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hsv dna quant","code_information":[{"code":"87530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna dir probe","code_information":[{"code":"87531","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.1,"maximum":115.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":115.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60.9,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna amp probe","code_information":[{"code":"87532","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hhv-6 dna quant","code_information":[{"code":"87533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.67,"maximum":83.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.85,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 dna dir probe","code_information":[{"code":"87534","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.82,"maximum":43.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.02,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 probe&reverse trnscrpj","code_information":[{"code":"87535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-1 quant&revrse trnscrpj","code_information":[{"code":"87536","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":80.84,"maximum":169.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":91.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.84,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.63,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":169.71,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":90.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89.36,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 dna dir probe","code_information":[{"code":"87537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.82,"maximum":43.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.82,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.02,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 probe&revrse trnscripj","code_information":[{"code":"87538","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hiv-2 quant&revrse trnscripj","code_information":[{"code":"87539","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.69,"maximum":116.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":116.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.55,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna dir prob","code_information":[{"code":"87540","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna amp prob","code_information":[{"code":"87541","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Legion pneumo dna quant","code_information":[{"code":"87542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.67,"maximum":83.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.85,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna dir probe","code_information":[{"code":"87550","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna amp probe","code_information":[{"code":"87551","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.83,"maximum":96.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":96.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.65,"additional_payer_notes":"APC"}]}]},{"description":"Mycobacteria dna quant","code_information":[{"code":"87552","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna dir probe","code_information":[{"code":"87555","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.54,"maximum":53.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.22,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna amp probe","code_information":[{"code":"87556","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.60,"maximum":83.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.6,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.76,"additional_payer_notes":"APC"}]}]},{"description":"M.tuberculo dna quant","code_information":[{"code":"87557","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna dir prob","code_information":[{"code":"87560","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.93,"maximum":54.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.35,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":54.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.65,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna amp prob","code_information":[{"code":"87561","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"M.avium-intra dna quant","code_information":[{"code":"87562","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"M. genitalium amp probe","code_information":[{"code":"87563","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Mtb rifampin rst amp prb tq","code_information":[{"code":"87564","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":72.93,"maximum":153.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":82.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":153.1,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":81.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80.61,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna dir probe","code_information":[{"code":"87580","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna amp probe","code_information":[{"code":"87581","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"M.pneumon dna quant","code_information":[{"code":"87582","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":287.49,"maximum":603.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":323.8,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":311.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":287.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":302.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":314.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":336.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":603.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":320.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":317.75,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna dir prob","code_information":[{"code":"87590","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.54,"maximum":53.61,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.61,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.22,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna amp prob","code_information":[{"code":"87591","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"N.gonorrhoeae dna quant","code_information":[{"code":"87592","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Orthopoxvirus amp prb each","code_information":[{"code":"87593","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.74,"maximum":102.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.88,"additional_payer_notes":"APC"}]}]},{"description":"Pneumcysts jirovecii amp prb","code_information":[{"code":"87594","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hpv low-risk types","code_information":[{"code":"87623","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hpv high-risk types","code_information":[{"code":"87624","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Hpv types 16 & 18 only","code_information":[{"code":"87625","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.52,"maximum":80.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.39,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.52,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.09,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":80.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.58,"additional_payer_notes":"APC"}]}]},{"description":"Hpv sep hi-rsk typ&pool rslt","code_information":[{"code":"87626","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.69,"maximum":140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":140.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.71,"additional_payer_notes":"APC"}]}]},{"description":"Jt spc pthgn&rx rsist gen26+","code_information":[{"code":"87627","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":645.78,"maximum":1355.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":727.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":700.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":645.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":679.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":706.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":755.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1355.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":720.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":713.76,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 3-5 targets","code_information":[{"code":"87631","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 6-11 targets","code_information":[{"code":"87632","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":207.16,"maximum":434.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.32,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":224.6,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":207.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":218.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":226.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":242.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":434.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":228.96,"additional_payer_notes":"APC"}]}]},{"description":"Resp virus 12-25 targets","code_information":[{"code":"87633","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":395.94,"maximum":831.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":445.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":429.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":395.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":416.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":433.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":463.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":831.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":441.79,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":437.62,"additional_payer_notes":"APC"}]}]},{"description":"Rsv dna/rna amp probe","code_information":[{"code":"87634","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.69,"maximum":140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":140.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.71,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid-19 amp prb","code_information":[{"code":"87635","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.74,"maximum":102.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.88,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2 & inf a&b amp prb","code_information":[{"code":"87636","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2&inf a&b&rsv amp prb","code_information":[{"code":"87637","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":135.50,"maximum":284.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":152.61,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":158.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":284.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.19,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":149.76,"additional_payer_notes":"APC"}]}]},{"description":"Staph a dna amp probe","code_information":[{"code":"87640","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Mr-staph dna amp probe","code_information":[{"code":"87641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna dir probe","code_information":[{"code":"87650","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna amp probe","code_information":[{"code":"87651","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Strep a dna quant","code_information":[{"code":"87652","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.67,"maximum":83.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":83.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.85,"additional_payer_notes":"APC"}]}]},{"description":"Strep b dna amp probe","code_information":[{"code":"87653","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas vagin dir probe","code_information":[{"code":"87660","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.05,"maximum":39.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.45,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.05,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.3,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.05,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas vaginalis amplif","code_information":[{"code":"87661","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Zika virus dna/rna amp probe","code_information":[{"code":"87662","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.74,"maximum":102.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.88,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna dir","code_information":[{"code":"87797","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.53,"maximum":59.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.13,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.93,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":59.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.83,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.53,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna amp","code_information":[{"code":"87798","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Detect agent nos dna quant","code_information":[{"code":"87799","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.70,"maximum":85.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":85.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"}]}]},{"description":"Detect agnt mult dna direc","code_information":[{"code":"87800","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.49,"maximum":87.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.85,"additional_payer_notes":"APC"}]}]},{"description":"Detect agnt mult dna ampli","code_information":[{"code":"87801","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":66.69,"maximum":140.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.31,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":140.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.71,"additional_payer_notes":"APC"}]}]},{"description":"Strep b assay w/optic","code_information":[{"code":"87802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.09,"maximum":25.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.62,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.16,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.49,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.37,"additional_payer_notes":"APC"}]}]},{"description":"Clostridium toxin a w/optic","code_information":[{"code":"87803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.2,"maximum":31.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.48,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":31.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.8,"additional_payer_notes":"APC"}]}]},{"description":"Influenza assay w/optic","code_information":[{"code":"87804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.72,"maximum":33.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.05,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"APC"}]}]},{"description":"Hiv antigen w/hiv antibodies","code_information":[{"code":"87806","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.13,"maximum":65.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.06,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.13,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":65.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.41,"additional_payer_notes":"APC"}]}]},{"description":"Rsv assay w/optic","code_information":[{"code":"87807","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.44,"maximum":26.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.44,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.76,"additional_payer_notes":"APC"}]}]},{"description":"Trichomonas assay w/optic","code_information":[{"code":"87808","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.53,"maximum":30.49,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.49,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.05,"additional_payer_notes":"APC"}]}]},{"description":"Adenovirus assay w/optic","code_information":[{"code":"87809","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.67,"maximum":43.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":43.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.85,"additional_payer_notes":"APC"}]}]},{"description":"Chylmd trach assay w/optic","code_information":[{"code":"87810","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.53,"maximum":70.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":70.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.41,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.05,"additional_payer_notes":"APC"}]}]},{"description":"Sars-cov-2 covid19 w/optic","code_information":[{"code":"87811","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":39.31,"maximum":82.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.01,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":82.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.45,"additional_payer_notes":"APC"}]}]},{"description":"Sarscov2&inf typ a&b w/optic","code_information":[{"code":"87812","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":70.76,"maximum":148.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":79.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.71,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.48,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":148.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.2,"additional_payer_notes":"APC"}]}]},{"description":"N. gonorrhoeae assay w/optic","code_information":[{"code":"87850","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.33,"maximum":48.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.31,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.79,"additional_payer_notes":"APC"}]}]},{"description":"Strep a assay w/optic","code_information":[{"code":"87880","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.70,"maximum":32.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.36,"additional_payer_notes":"APC"}]}]},{"description":"Agent nos assay w/optic","code_information":[{"code":"87899","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.27,"maximum":32.05,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":32.05,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.03,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.87,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype infect agent drug","code_information":[{"code":"87900","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":123.83,"maximum":259.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":139.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":134.26,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":135.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":259.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":138.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":136.87,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna hiv reverse t","code_information":[{"code":"87901","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.58,"maximum":513.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":275.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":244.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":513.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.32,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna/rna hep c","code_information":[{"code":"87902","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.58,"maximum":513.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":275.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":244.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":513.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.32,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype dna hiv w/culture","code_information":[{"code":"87903","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":464.23,"maximum":974.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":522.87,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":503.32,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":464.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":488.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":508.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":543.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":974.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":517.98,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":513.09,"additional_payer_notes":"APC"}]}]},{"description":"Phenotype dna hiv w/clt add","code_information":[{"code":"87904","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.77,"maximum":51.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":51.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.63,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.37,"additional_payer_notes":"APC"}]}]},{"description":"Sialidase enzyme assay","code_information":[{"code":"87905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.61,"maximum":24.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.08,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.95,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna/rna hiv","code_information":[{"code":"87906","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":122.29,"maximum":256.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":137.74,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":132.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":256.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":135.17,"additional_payer_notes":"APC"}]}]},{"description":"Genotype cytomegalovirus","code_information":[{"code":"87910","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.58,"maximum":513.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":275.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":244.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":513.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.32,"additional_payer_notes":"APC"}]}]},{"description":"Genotype dna hepatitis b","code_information":[{"code":"87912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":244.58,"maximum":513.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":275.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":265.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":244.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":257.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":267.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":286.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":513.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":272.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":270.32,"additional_payer_notes":"APC"}]}]},{"description":"Sex chromatin identification","code_information":[{"code":"88130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.08,"maximum":35.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.88,"additional_payer_notes":"APC"}]}]},{"description":"Sex chromatin identification","code_information":[{"code":"88140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.59,"maximum":15.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.88,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.39,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v thin layer","code_information":[{"code":"88142","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.25,"maximum":40.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v thin layer redo","code_information":[{"code":"88143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.89,"maximum":45.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.89,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.42,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.19,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v automated","code_information":[{"code":"88147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.03,"maximum":100.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":100.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.59,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.09,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto rescreen","code_information":[{"code":"88148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v manual","code_information":[{"code":"88150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto redo","code_information":[{"code":"88152","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.26,"maximum":55.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":55.12,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.02,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v redo","code_information":[{"code":"88153","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.83,"maximum":47.92,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":47.92,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.23,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v index add-on","code_information":[{"code":"88155","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.92,"maximum":29.22,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.09,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.92,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.65,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.22,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.38,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v manual","code_information":[{"code":"88164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v redo","code_information":[{"code":"88165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.11,"maximum":84.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.11,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.75,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.33,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v auto redo","code_information":[{"code":"88166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath tbs c/v select","code_information":[{"code":"88167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto in fluid","code_information":[{"code":"88174","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":24.10,"maximum":50.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.13,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.64,"additional_payer_notes":"APC"}]}]},{"description":"Cytopath c/v auto fluid redo","code_information":[{"code":"88175","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.28,"maximum":53.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.47,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.59,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.94,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture lymphocyte","code_information":[{"code":"88230","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":110.67,"maximum":232.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":124.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.98,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.67,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":232.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.31,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture skin/biopsy","code_information":[{"code":"88233","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":133.69,"maximum":280.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":280.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":147.77,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture placenta","code_information":[{"code":"88235","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.78,"maximum":299.74,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.81,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":299.74,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157.82,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture bone marrow","code_information":[{"code":"88237","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":136.56,"maximum":286.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":153.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":143.75,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":149.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":286.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":152.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":150.94,"additional_payer_notes":"APC"}]}]},{"description":"Tissue culture tumor","code_information":[{"code":"88239","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":140.14,"maximum":294.20,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.14,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":147.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":153.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.04,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":294.2,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.37,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154.9,"additional_payer_notes":"APC"}]}]},{"description":"Cell cryopreserve/storage","code_information":[{"code":"88240","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.42,"maximum":26.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.72,"additional_payer_notes":"APC"}]}]},{"description":"Frozen cell preparation","code_information":[{"code":"88241","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.49,"maximum":24.11,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.45,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.11,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.69,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 20-25","code_information":[{"code":"88245","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.51,"maximum":345.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":185.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":345.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":181.83,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 50-100","code_information":[{"code":"88248","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.51,"maximum":345.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":185.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":345.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":181.83,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 100","code_information":[{"code":"88249","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.51,"maximum":345.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":185.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.37,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.17,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":192.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":345.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":183.56,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":181.83,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 5","code_information":[{"code":"88261","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":251.12,"maximum":527.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":282.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":272.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":251.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":264.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":293.95,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":527.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":280.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":277.56,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 15-20","code_information":[{"code":"88262","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":119.22,"maximum":250.26,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":134.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.22,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":125.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":139.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":250.26,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":133.02,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.76,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 45","code_information":[{"code":"88263","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":142.78,"maximum":299.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":160.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":142.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":167.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":299.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":157.8,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analysis 20-25","code_information":[{"code":"88264","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":137.38,"maximum":288.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":154.73,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.95,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":150.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":160.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":288.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":153.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":151.84,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analys placenta","code_information":[{"code":"88267","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":179.14,"maximum":376.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":201.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":194.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":179.14,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":196.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":209.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":376.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":199.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":198.0,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome analys amniotic","code_information":[{"code":"88269","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":164.98,"maximum":346.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":185.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":178.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":164.98,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":173.66,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":180.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":193.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":346.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":184.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":182.34,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics dna probe","code_information":[{"code":"88271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.35,"maximum":42.72,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.72,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.71,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.49,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 3-5","code_information":[{"code":"88272","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.66,"maximum":81.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.92,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.7,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":81.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":42.74,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 10-30","code_information":[{"code":"88273","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.07,"maximum":69.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.71,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.55,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 25-99","code_information":[{"code":"88274","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":40.26,"maximum":84.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":45.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":84.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":44.5,"additional_payer_notes":"APC"}]}]},{"description":"Cytogenetics 100-300","code_information":[{"code":"88275","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.63,"maximum":102.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":56.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.75,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome karyotype study","code_information":[{"code":"88280","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.80,"maximum":66.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.47,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":66.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.14,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome banding study","code_information":[{"code":"88283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.17,"maximum":136.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":73.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":136.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72.03,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome count additional","code_information":[{"code":"88285","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.56,"maximum":53.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.79,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.26,"additional_payer_notes":"APC"}]}]},{"description":"Chromosome study additional","code_information":[{"code":"88289","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.71,"maximum":68.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.46,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":68.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.15,"additional_payer_notes":"APC"}]}]},{"description":"Bilirubin total transcut","code_information":[{"code":"88720","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.77,"maximum":10.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"}]}]},{"description":"Hgb quant transcutaneous","code_information":[{"code":"88738","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.77,"maximum":10.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.37,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.17,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":10.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"APC"}]}]},{"description":"Transcutaneous carboxyhb","code_information":[{"code":"88740","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.90,"maximum":18.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"}]}]},{"description":"Transcutaneous methb","code_information":[{"code":"88741","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.90,"maximum":18.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.65,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.9,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.93,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid cell count","code_information":[{"code":"89050","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.48,"maximum":9.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.91,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.96,"additional_payer_notes":"APC"}]}]},{"description":"Body fluid cell count","code_information":[{"code":"89051","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.32,"maximum":11.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.6,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"}]}]},{"description":"Leukocyte assessment fecal","code_information":[{"code":"89055","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.06,"maximum":8.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Exam synovial fluid crystals","code_information":[{"code":"89060","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.96,"maximum":14.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":14.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.7,"additional_payer_notes":"APC"}]}]},{"description":"Specimen fat stain","code_information":[{"code":"89125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.59,"maximum":11.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"}]}]},{"description":"Exam feces for meat fibers","code_information":[{"code":"89160","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.61,"maximum":9.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.19,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.09,"additional_payer_notes":"APC"}]}]},{"description":"Nasal smear for eosinophils","code_information":[{"code":"89190","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.50,"maximum":11.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.08,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis w/huhner","code_information":[{"code":"89300","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.35,"maximum":19.62,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.53,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.62,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.33,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis w/count","code_information":[{"code":"89310","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.18,"maximum":17.17,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.57,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":17.17,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.04,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal vol/count/mot","code_information":[{"code":"89320","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.69,"maximum":24.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.68,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.69,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.55,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.05,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.93,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal sperm detection","code_information":[{"code":"89321","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.45,"maximum":24.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.89,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.45,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.53,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.4,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.65,"additional_payer_notes":"APC"}]}]},{"description":"Semen anal strict criteria","code_information":[{"code":"89322","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.72,"maximum":30.91,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.96,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.24,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.91,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.28,"additional_payer_notes":"APC"}]}]},{"description":"Sperm antibody test","code_information":[{"code":"89325","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.14,"maximum":21.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.14,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":21.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.31,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.2,"additional_payer_notes":"APC"}]}]},{"description":"Sperm evaluation test","code_information":[{"code":"89329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.61,"maximum":39.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.57,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation cervical mucus","code_information":[{"code":"89330","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.86,"maximum":20.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":11.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":20.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.0,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.9,"additional_payer_notes":"APC"}]}]},{"description":"Retrograde ejaculation anal","code_information":[{"code":"89331","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.61,"maximum":39.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.18,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.37,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.77,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.57,"additional_payer_notes":"APC"}]}]},{"description":"Semen analysis","code_information":[{"code":"G0027","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.18,"maximum":12.96,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.23,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.96,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.82,"additional_payer_notes":"APC"}]}]},{"description":"PSA Screening","code_information":[{"code":"G0103","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.34,"maximum":38.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":38.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.28,"additional_payer_notes":"APC"}]}]},{"description":"Screen cerv/vag thin layer","code_information":[{"code":"G0123","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.25,"maximum":40.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.68,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.53,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.27,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0143","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.70,"maximum":53.95,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.08,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.95,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.4,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0144","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":41.77,"maximum":87.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":47.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":41.77,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":87.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":46.17,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto,thinlayer,rescr","code_information":[{"code":"G0145","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.17,"maximum":52.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.34,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.17,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":52.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":27.81,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto, automated sys","code_information":[{"code":"G0147","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Scr c/v cyto, autosys, rescr","code_information":[{"code":"G0148","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.34,"maximum":63.70,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.52,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63.7,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.54,"additional_payer_notes":"APC"}]}]},{"description":"CBC/diffwbc w/o platelet","code_information":[{"code":"G0306","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.38,"maximum":15.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.64,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.24,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.16,"additional_payer_notes":"APC"}]}]},{"description":"CBC without platelet","code_information":[{"code":"G0307","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.15,"maximum":12.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.92,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":12.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.86,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.79,"additional_payer_notes":"APC"}]}]},{"description":"Fecal blood scrn immunoassay","code_information":[{"code":"G0328","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.15,"maximum":36.00,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.15,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.05,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.0,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.95,"additional_payer_notes":"APC"}]}]},{"description":"EIA HIV-1/HIV-2 screen","code_information":[{"code":"G0432","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.59,"maximum":39.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.16,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.59,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.76,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.55,"additional_payer_notes":"APC"}]}]},{"description":"ELISA HIV-1/HIV-2 screen","code_information":[{"code":"G0433","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.38,"maximum":36.48,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.48,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.2,"additional_payer_notes":"APC"}]}]},{"description":"Oral hiv-1/hiv-2 screen","code_information":[{"code":"G0435","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.38,"maximum":23.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.82,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.34,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.38,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.32,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.58,"additional_payer_notes":"APC"}]}]},{"description":"Hep c screen high risk/other","code_information":[{"code":"G0472","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":44.03,"maximum":92.44,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":49.59,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.74,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":44.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.35,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.2,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":92.44,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":48.67,"additional_payer_notes":"APC"}]}]},{"description":"Hiv combination assay","code_information":[{"code":"G0475","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":22.88,"maximum":48.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.8,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.88,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":48.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":25.28,"additional_payer_notes":"APC"}]}]},{"description":"Hpv combo assay ca screen","code_information":[{"code":"G0476","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 1-7 classes","code_information":[{"code":"G0480","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":108.71,"maximum":228.21,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":122.44,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.71,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":119.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":228.21,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":121.3,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":120.15,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 8-14 classes","code_information":[{"code":"G0481","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":148.76,"maximum":312.29,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":167.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":161.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":148.76,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":156.59,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":162.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":174.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":312.29,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":165.99,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":164.42,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 15-21 classes","code_information":[{"code":"G0482","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":188.80,"maximum":396.35,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":212.65,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":204.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":188.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":198.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":206.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":221.0,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":396.35,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":210.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":208.68,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def 22+ classes","code_information":[{"code":"G0483","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":234.57,"maximum":492.43,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":264.2,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":254.33,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":234.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":246.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":256.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":274.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":492.43,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":261.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":259.27,"additional_payer_notes":"APC"}]}]},{"description":"Hepb screen high risk indiv","code_information":[{"code":"G0499","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":26.86,"maximum":56.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.25,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.12,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.86,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.44,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":56.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":29.68,"additional_payer_notes":"APC"}]}]},{"description":"Screening Hep C detect","code_information":[{"code":"G0567","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":33.34,"maximum":69.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.49,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.02,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":69.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.84,"additional_payer_notes":"APC"}]}]},{"description":"Drug test def simple all cl","code_information":[{"code":"G0659","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.03,"maximum":123.93,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.49,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":64.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.1,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":123.93,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":65.25,"additional_payer_notes":"APC"}]}]},{"description":"Cephalin floculation test","code_information":[{"code":"P2028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.70,"maximum":9.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"}]}]},{"description":"Congo red blood test","code_information":[{"code":"P2029","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.70,"maximum":9.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"}]}]},{"description":"Blood thymol turbidity","code_information":[{"code":"P2033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.70,"maximum":9.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"}]}]},{"description":"Blood mucoprotein","code_information":[{"code":"P2038","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.70,"maximum":9.87,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.3,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.7,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.15,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":9.87,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.25,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.2,"additional_payer_notes":"APC"}]}]},{"description":"Screen pap by tech w md supv","code_information":[{"code":"P3000","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Catheterize for urine spec","code_information":[{"code":"P9612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":8.87,"maximum":18.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.62,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":18.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.9,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":9.81,"additional_payer_notes":"APC"}]}]},{"description":"Wet mounts/ w preparations","code_information":[{"code":"Q0111","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.61,"maximum":36.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.62,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.47,"additional_payer_notes":"APC"}]}]},{"description":"Potassium hydroxide preps","code_information":[{"code":"Q0112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.54,"maximum":11.63,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.54,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.06,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.63,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":6.12,"additional_payer_notes":"APC"}]}]},{"description":"Pinworm examinations","code_information":[{"code":"Q0113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":4.06,"maximum":8.52,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.57,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.06,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.44,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":8.52,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":4.53,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":4.48,"additional_payer_notes":"APC"}]}]},{"description":"Fern test","code_information":[{"code":"Q0114","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":9.25,"maximum":19.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.42,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":19.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.32,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":10.23,"additional_payer_notes":"APC"}]}]},{"description":"Post-coital mucous exam","code_information":[{"code":"Q0115","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.75,"maximum":49.86,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.75,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":49.86,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.25,"additional_payer_notes":"APC"}]}]},{"description":"2019 nCoV diagnostic P","code_information":[{"code":"U0001","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.12,"maximum":71.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.12,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":71.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":37.72,"additional_payer_notes":"APC"}]}]},{"description":"COVID-19 lab test non-CDC","code_information":[{"code":"U0002","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":48.74,"maximum":102.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.85,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.31,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.06,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":102.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":53.88,"additional_payer_notes":"APC"}]}]},{"description":"Cntct lens hydrophil photoch","code_information":[{"code":"V2524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":146.73,"maximum":308.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":165.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":159.08,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":146.73,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":154.45,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":160.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":171.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":308.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":163.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":162.17,"additional_payer_notes":"APC"}]}]},{"description":"Electrical bone stimulation","code_information":[{"code":"20974","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":49.72,"maximum":104.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":56.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.72,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":52.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":104.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.48,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":54.96,"additional_payer_notes":"APC"}]}]},{"description":"Bfb training 1st 15 min","code_information":[{"code":"90912","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.1,"maximum":75.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.66,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.14,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.1,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.26,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":75.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":39.9,"additional_payer_notes":"APC"}]}]},{"description":"Bfb training ea addl 15 min","code_information":[{"code":"90913","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":20.33,"maximum":42.68,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.9,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.04,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.26,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":42.68,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.68,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":22.47,"additional_payer_notes":"APC"}]}]},{"description":"Speech/hearing therapy","code_information":[{"code":"92507","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":71.16,"maximum":149.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":80.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.16,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":77.9,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":83.29,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":149.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":78.65,"additional_payer_notes":"APC"}]}]},{"description":"Speech/hearing therapy","code_information":[{"code":"92508","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":23.83,"maximum":50.02,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.83,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.83,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.08,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.89,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":50.02,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":26.33,"additional_payer_notes":"APC"}]}]},{"description":"Evaluation of speech fluency","code_information":[{"code":"92521","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":129.35,"maximum":271.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":145.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":140.24,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":129.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":136.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":141.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":151.41,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":271.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":144.33,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":142.97,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate speech production","code_information":[{"code":"92522","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":104.99,"maximum":220.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118.26,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":113.84,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.99,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.52,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":122.9,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":220.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.15,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.05,"additional_payer_notes":"APC"}]}]},{"description":"Speech sound lang comprehen","code_information":[{"code":"92523","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":211.20,"maximum":443.37,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":237.88,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":228.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":211.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":222.32,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":231.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":247.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":443.37,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":235.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":233.44,"additional_payer_notes":"APC"}]}]},{"description":"Behavral qualit analys voice","code_information":[{"code":"92524","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":105.39,"maximum":221.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":118.71,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":114.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.39,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":115.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.37,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":221.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.6,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":116.49,"additional_payer_notes":"APC"}]}]},{"description":"Oral function therapy","code_information":[{"code":"92526","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":78.49,"maximum":164.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.1,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":78.49,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":82.62,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":85.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":164.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":86.75,"additional_payer_notes":"APC"}]}]},{"description":"Oral speech device eval","code_information":[{"code":"92597","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":68.47,"maximum":143.73,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":77.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.47,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":72.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":74.95,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":80.14,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":143.73,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.39,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":75.67,"additional_payer_notes":"APC"}]}]},{"description":"Ex for speech device rx 1hr","code_information":[{"code":"92607","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":117.14,"maximum":245.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":131.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":127.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":117.14,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":123.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":128.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":137.11,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":245.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":130.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":129.46,"additional_payer_notes":"APC"}]}]},{"description":"Ex for speech device rx addl","code_information":[{"code":"92608","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.32,"maximum":97.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.17,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.22,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":97.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.69,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.2,"additional_payer_notes":"APC"}]}]},{"description":"Use of speech device service","code_information":[{"code":"92609","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":99.93,"maximum":209.78,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":112.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":108.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.19,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":116.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":209.78,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":111.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":110.45,"additional_payer_notes":"APC"}]}]},{"description":"Evaluate swallowing function","code_information":[{"code":"92610","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":55.93,"maximum":117.40,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":62.99,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.64,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.93,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":61.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.46,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":117.4,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.4,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.81,"additional_payer_notes":"APC"}]}]},{"description":"Motion fluoroscopy/swallow","code_information":[{"code":"92611","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":88.80,"maximum":186.41,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.01,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":88.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":97.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":186.41,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.08,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":98.14,"additional_payer_notes":"APC"}]}]},{"description":"Endoscopy swallow (fees) vid","code_information":[{"code":"92612","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.25,"maximum":113.89,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.11,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.82,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.25,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.11,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.39,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":113.89,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.54,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.97,"additional_payer_notes":"APC"}]}]},{"description":"Laryngoscopic sensory vid","code_information":[{"code":"92614","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":53.08,"maximum":111.42,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":59.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.55,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":55.87,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.1,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.13,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":111.42,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.22,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":58.66,"additional_payer_notes":"APC"}]}]},{"description":"Fees w/laryngeal sense test","code_information":[{"code":"92616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":79.87,"maximum":167.66,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":89.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":86.59,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":79.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":84.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":87.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":167.66,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":89.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":88.27,"additional_payer_notes":"APC"}]}]},{"description":"Range of motion measurements","code_information":[{"code":"95851","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.46,"maximum":13.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.28,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.56,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"}]}]},{"description":"Range of motion measurements","code_information":[{"code":"95852","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.28,"maximum":11.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.78,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.18,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.89,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.84,"additional_payer_notes":"APC"}]}]},{"description":"Assessment of aphasia","code_information":[{"code":"96105","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":94.08,"maximum":197.50,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.96,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.0,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":94.08,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.03,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":110.12,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":197.5,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.97,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.98,"additional_payer_notes":"APC"}]}]},{"description":"Cognitive test by hc pro","code_information":[{"code":"96125","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":96.50,"maximum":202.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":108.69,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.5,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.58,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":105.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":112.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":202.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":107.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":106.66,"additional_payer_notes":"APC"}]}]},{"description":"Mlt fam grp bhv train 1st 60","code_information":[{"code":"96202","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.79,"maximum":35.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.2,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.38,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.65,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.55,"additional_payer_notes":"APC"}]}]},{"description":"Mlt fam grp bhv train ea add","code_information":[{"code":"96203","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":5.27,"maximum":11.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.94,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.72,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.27,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.17,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":11.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":5.88,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":5.83,"additional_payer_notes":"APC"}]}]},{"description":"Mechanical traction therapy","code_information":[{"code":"97012","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":13.56,"maximum":28.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.27,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.7,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.87,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":28.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.13,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.98,"additional_payer_notes":"APC"}]}]},{"description":"Vasopneumatic device therapy","code_information":[{"code":"97016","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.34,"maximum":23.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.3,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.28,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.66,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.54,"additional_payer_notes":"APC"}]}]},{"description":"Paraffin bath therapy","code_information":[{"code":"97018","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.34,"maximum":13.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.14,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.87,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.34,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.67,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.94,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.42,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.0,"additional_payer_notes":"APC"}]}]},{"description":"Whirlpool therapy","code_information":[{"code":"97022","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":15.78,"maximum":33.13,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.77,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.11,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.78,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.13,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.44,"additional_payer_notes":"APC"}]}]},{"description":"Diathermy eg microwave","code_information":[{"code":"97024","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.30,"maximum":15.32,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.91,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.3,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":15.32,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.06,"additional_payer_notes":"APC"}]}]},{"description":"Infrared therapy","code_information":[{"code":"97026","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":6.66,"maximum":13.98,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.5,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":6.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.01,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.29,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.8,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":13.98,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.43,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":7.36,"additional_payer_notes":"APC"}]}]},{"description":"Ultraviolet therapy","code_information":[{"code":"97028","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":7.87,"maximum":16.51,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.53,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":7.87,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":9.21,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":16.51,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":8.78,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":8.69,"additional_payer_notes":"APC"}]}]},{"description":"Electrical stimulation","code_information":[{"code":"97032","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.29,"maximum":29.99,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.09,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.29,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.04,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.72,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.99,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.79,"additional_payer_notes":"APC"}]}]},{"description":"Electric current therapy","code_information":[{"code":"97033","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":18.96,"maximum":39.81,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.36,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.56,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.96,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.2,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":39.81,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.16,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":20.96,"additional_payer_notes":"APC"}]}]},{"description":"Contrast bath therapy","code_information":[{"code":"97034","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.07,"maximum":29.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.85,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.07,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.81,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.47,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":29.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.7,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.55,"additional_payer_notes":"APC"}]}]},{"description":"Ultrasound therapy","code_information":[{"code":"97035","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":14.40,"maximum":30.23,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":16.22,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.61,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.16,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":15.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.86,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":30.23,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.07,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":15.92,"additional_payer_notes":"APC"}]}]},{"description":"Hydrotherapy","code_information":[{"code":"97036","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.46,"maximum":72.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.81,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.36,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.46,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.72,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.33,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.08,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic exercises","code_information":[{"code":"97110","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.03,"maximum":58.85,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.58,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.4,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.69,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.85,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.28,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.99,"additional_payer_notes":"APC"}]}]},{"description":"Neuromuscular reeducation","code_information":[{"code":"97112","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.60,"maximum":64.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.18,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.6,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.82,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.14,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.82,"additional_payer_notes":"APC"}]}]},{"description":"Aquatic therapy/exercises","code_information":[{"code":"97113","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.51,"maximum":76.64,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":41.12,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.58,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.51,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.43,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.97,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.64,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.35,"additional_payer_notes":"APC"}]}]},{"description":"Gait training therapy","code_information":[{"code":"97116","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":28.62,"maximum":60.09,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":32.24,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.03,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.62,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.13,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.34,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":60.09,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.94,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.64,"additional_payer_notes":"APC"}]}]},{"description":"Massage therapy","code_information":[{"code":"97124","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.66,"maximum":58.07,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":31.16,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.99,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.66,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":58.07,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.87,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.58,"additional_payer_notes":"APC"}]}]},{"description":"Ther ivntj 1st 15 min","code_information":[{"code":"97129","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":19.31,"maximum":40.54,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.75,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.94,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.31,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.33,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.14,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.61,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":40.54,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.55,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":21.35,"additional_payer_notes":"APC"}]}]},{"description":"Ther ivntj ea addl 15 min","code_information":[{"code":"97130","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17.55,"maximum":36.83,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.76,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.02,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.55,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":20.54,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":36.83,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.39,"additional_payer_notes":"APC"}]}]},{"description":"Manual therapy 1/> regions","code_information":[{"code":"97140","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":27.33,"maximum":57.38,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.78,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.63,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.33,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.99,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":57.38,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.5,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":30.21,"additional_payer_notes":"APC"}]}]},{"description":"Group therapeutic procedures","code_information":[{"code":"97150","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.96,"maximum":35.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":19.1,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.39,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":19.85,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":35.6,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.92,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.74,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval low complex 20 min","code_information":[{"code":"97161","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.79,"maximum":196.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.69,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.68,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.79,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":196.9,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.65,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.67,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval mod complex 30 min","code_information":[{"code":"97162","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":91.2,"maximum":191.45,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":102.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.88,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":91.2,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":96.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":99.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.75,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":191.45,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.76,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":100.8,"additional_payer_notes":"APC"}]}]},{"description":"Pt eval high complex 45 min","code_information":[{"code":"97163","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":95.26,"maximum":199.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":107.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":103.28,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":95.26,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":100.27,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.28,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":111.5,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":199.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":106.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.28,"additional_payer_notes":"APC"}]}]},{"description":"Pt re-eval est plan care","code_information":[{"code":"97164","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":62.79,"maximum":131.80,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":70.72,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":62.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":68.73,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.49,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":131.8,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.06,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":69.39,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval low complex 30 min","code_information":[{"code":"97165","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.63,"maximum":196.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":196.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.49,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval mod complex 45 min","code_information":[{"code":"97166","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.63,"maximum":196.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":196.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.49,"additional_payer_notes":"APC"}]}]},{"description":"Ot eval high complex 60 min","code_information":[{"code":"97167","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":93.63,"maximum":196.56,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":105.46,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":101.52,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":93.63,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":98.56,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":102.5,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":109.6,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":196.56,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":104.47,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":103.49,"additional_payer_notes":"APC"}]}]},{"description":"Ot re-eval est plan care","code_information":[{"code":"97168","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":65.75,"maximum":138.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":74.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.29,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.75,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":69.21,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":71.98,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":76.96,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":138.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":73.36,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":72.67,"additional_payer_notes":"APC"}]}]},{"description":"Therapeutic activities","code_information":[{"code":"97530","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":34.58,"maximum":72.59,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.95,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.49,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.58,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":37.86,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":72.59,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.58,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":38.22,"additional_payer_notes":"APC"}]}]},{"description":"Sensory Integration","code_information":[{"code":"97533","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":59.96,"maximum":125.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":67.54,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.12,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":65.64,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":70.19,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":125.88,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":66.91,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":66.28,"additional_payer_notes":"APC"}]}]},{"description":"Self care mngment training","code_information":[{"code":"97535","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.23,"maximum":63.46,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.05,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.77,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.23,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.82,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.09,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.38,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":63.46,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.73,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.41,"additional_payer_notes":"APC"}]}]},{"description":"Community/work reintegration","code_information":[{"code":"97537","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":31.56,"maximum":66.25,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.55,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":31.56,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.22,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.55,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.94,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":66.25,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.21,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.88,"additional_payer_notes":"APC"}]}]},{"description":"Wheelchair mngment training","code_information":[{"code":"97542","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":30.57,"maximum":64.18,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":34.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.15,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":30.57,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":33.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.78,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":64.18,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.11,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":33.79,"additional_payer_notes":"APC"}]}]},{"description":"Physical performance test","code_information":[{"code":"97750","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":32.53,"maximum":68.28,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":36.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.27,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":32.53,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":34.24,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":35.61,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.07,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":68.28,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.29,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":35.95,"additional_payer_notes":"APC"}]}]},{"description":"Assistive technology assess","code_information":[{"code":"97755","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":36.32,"maximum":76.24,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.91,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.38,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":36.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.23,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":39.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.51,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":76.24,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.52,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":40.14,"additional_payer_notes":"APC"}]}]},{"description":"Orthotic mgmt and training","code_information":[{"code":"97760","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":45.41,"maximum":95.33,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.15,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.23,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.41,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":47.8,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":49.71,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":53.15,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":95.33,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.67,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":50.19,"additional_payer_notes":"APC"}]}]},{"description":"Prosthetic training","code_information":[{"code":"97761","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":38.94,"maximum":81.75,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.86,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.22,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":38.94,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":40.99,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":42.63,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":45.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":81.75,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":43.45,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":43.04,"additional_payer_notes":"APC"}]}]},{"description":"Orthc/prostc mgmt sbsq enc","code_information":[{"code":"97763","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":46.35,"maximum":97.30,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":52.21,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.25,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":46.35,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":48.79,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":50.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.25,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":97.3,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":51.72,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":51.23,"additional_payer_notes":"APC"}]}]},{"description":"Medical nutrition indiv in","code_information":[{"code":"97802","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":25.43,"maximum":53.39,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.64,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.57,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.43,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":26.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":27.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":29.77,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":53.39,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":28.38,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":28.11,"additional_payer_notes":"APC"}]}]},{"description":"Med nutrition indiv subseq","code_information":[{"code":"97803","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.28,"maximum":44.67,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.97,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.07,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.28,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.4,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.3,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.91,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":44.67,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.74,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.52,"additional_payer_notes":"APC"}]}]},{"description":"Medical nutrition group","code_information":[{"code":"97804","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.74,"maximum":24.65,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.23,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.73,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.74,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.36,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.85,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.74,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.65,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.1,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.98,"additional_payer_notes":"APC"}]}]},{"description":"Vr cbt therapy","code_information":[{"code":"E1905","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":641.03,"maximum":1345.69,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":722.0,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":695.01,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":641.03,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":674.77,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":701.76,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":750.34,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":1345.69,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":715.26,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":708.51,"additional_payer_notes":"APC"}]}]},{"description":"Diab manage trn  per indiv","code_information":[{"code":"G0108","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":54.32,"maximum":114.03,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":61.18,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":58.9,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":54.32,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":57.18,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":59.47,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":63.58,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":114.03,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":60.61,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":60.04,"additional_payer_notes":"APC"}]}]},{"description":"Diab manage trn ind/group","code_information":[{"code":"G0109","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":16.00,"maximum":33.58,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":18.02,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.35,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.0,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":16.84,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.51,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":18.73,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":33.58,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":17.85,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":17.68,"additional_payer_notes":"APC"}]}]},{"description":"MNT subs tx for change dx","code_information":[{"code":"G0270","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":21.69,"maximum":45.53,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":24.43,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.51,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":21.69,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":22.83,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":23.74,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":25.39,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":45.53,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":24.2,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":23.97,"additional_payer_notes":"APC"}]}]},{"description":"Group MNT 2 or more 30 mins","code_information":[{"code":"G0271","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.37,"maximum":25.97,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.93,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.41,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.37,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.02,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.48,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":25.97,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.8,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.67,"additional_payer_notes":"APC"}]}]},{"description":"Elec stim unattend for press","code_information":[{"code":"G0281","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":11.80,"maximum":24.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.29,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.8,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.42,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.92,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.81,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":24.77,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.17,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":13.04,"additional_payer_notes":"APC"}]}]},{"description":"Elec stim other than wound","code_information":[{"code":"G0283","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":12.79,"maximum":26.84,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.4,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.86,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.79,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":13.46,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.97,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":26.84,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":14.27,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":14.13,"additional_payer_notes":"APC"}]}]},{"description":"Electromagntic tx for ulcers","code_information":[{"code":"G0329","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":10.96,"maximum":23.01,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.35,"additional_payer_notes":"APC"},{"payer_name":"Bcbs","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.89,"additional_payer_notes":"APC"},{"payer_name":"Florida Health Care Plan","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":10.96,"additional_payer_notes":"Radiation Therapy"},{"payer_name":"Health First Health Plans","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":11.54,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Careplus Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.0,"additional_payer_notes":"APC"},{"payer_name":"Humana","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.83,"additional_payer_notes":"APC"},{"payer_name":"Oscar","plan_name":"Individual Epo","methodology":"fee schedule","standard_charge_dollar":23.01,"additional_payer_notes":"APC"},{"payer_name":"Simply Healthcare","plan_name":"Medicare Managed Care - Hmo","methodology":"fee schedule","standard_charge_dollar":12.23,"additional_payer_notes":"APC"},{"payer_name":"Unitedhealthcare","plan_name":"Medicare Managed Care - Hmo/Ppo","methodology":"fee schedule","standard_charge_dollar":12.12,"additional_payer_notes":"APC"}]}]}]}